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Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma

Primary central nervous system lymphoma (PCNSL) is a rare malignancy. Standard of care is upfront high-dose methotrexate (HD-MTX) chemotherapy, while cranial radiation is more commonly used in the salvage setting. In this retrospective study, we aimed to investigate the safety and efficacy of salvag...

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Autores principales: Volpini, Matthew E., Song, Jiheon, Samant, Rajiv, MacDonald, David, Nair, Vimoj J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689217/
https://www.ncbi.nlm.nih.gov/pubmed/36354704
http://dx.doi.org/10.3390/curroncol29110644
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author Volpini, Matthew E.
Song, Jiheon
Samant, Rajiv
MacDonald, David
Nair, Vimoj J.
author_facet Volpini, Matthew E.
Song, Jiheon
Samant, Rajiv
MacDonald, David
Nair, Vimoj J.
author_sort Volpini, Matthew E.
collection PubMed
description Primary central nervous system lymphoma (PCNSL) is a rare malignancy. Standard of care is upfront high-dose methotrexate (HD-MTX) chemotherapy, while cranial radiation is more commonly used in the salvage setting. In this retrospective study, we aimed to investigate the safety and efficacy of salvage cranial radiation in PCNSL. PCNSL patients who received upfront HD-MTX chemotherapy and salvage cranial radiation after treatment failure between 1995 and 2018 were selected. Radiological response to cranial radiation was assessed as per Response Assessment in Neuro-Oncology Criteria. Twenty one patients were selected (median age 59.9 years), with median follow-up of 19.9 months. Fourteen patients (66.7%) received a boost to the gross tumour volume (GTV). Four patients (19.0%) sustained grade ≥2 treatment-related neurotoxicity post-completion of cranial radiation. Of the 19 patients who had requisite MRI with gadolinium imaging available for Response Assessment in Neuro-Oncology (RANO) criteria assessment, 47.4% achieved complete response, 47.4% achieved partial response, and 5.3% of patients exhibited stable disease. Higher dose to the whole brain (>30 Gy) was associated with higher rate of complete response (63.6%) than lower dose (≤30 Gy, 37.5%), while boost dose to the gross disease was also associated with higher rate of complete response (61.5%) compared with no boost dose (33.3%). Median overall survival was 20.0 months. PCNSL patients who relapsed following upfront chemotherapy showed a high rate of response to salvage cranial radiation, especially in those receiving greater than 30 Gy to the whole brain and boost to gross disease.
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spelling pubmed-96892172022-11-25 Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma Volpini, Matthew E. Song, Jiheon Samant, Rajiv MacDonald, David Nair, Vimoj J. Curr Oncol Article Primary central nervous system lymphoma (PCNSL) is a rare malignancy. Standard of care is upfront high-dose methotrexate (HD-MTX) chemotherapy, while cranial radiation is more commonly used in the salvage setting. In this retrospective study, we aimed to investigate the safety and efficacy of salvage cranial radiation in PCNSL. PCNSL patients who received upfront HD-MTX chemotherapy and salvage cranial radiation after treatment failure between 1995 and 2018 were selected. Radiological response to cranial radiation was assessed as per Response Assessment in Neuro-Oncology Criteria. Twenty one patients were selected (median age 59.9 years), with median follow-up of 19.9 months. Fourteen patients (66.7%) received a boost to the gross tumour volume (GTV). Four patients (19.0%) sustained grade ≥2 treatment-related neurotoxicity post-completion of cranial radiation. Of the 19 patients who had requisite MRI with gadolinium imaging available for Response Assessment in Neuro-Oncology (RANO) criteria assessment, 47.4% achieved complete response, 47.4% achieved partial response, and 5.3% of patients exhibited stable disease. Higher dose to the whole brain (>30 Gy) was associated with higher rate of complete response (63.6%) than lower dose (≤30 Gy, 37.5%), while boost dose to the gross disease was also associated with higher rate of complete response (61.5%) compared with no boost dose (33.3%). Median overall survival was 20.0 months. PCNSL patients who relapsed following upfront chemotherapy showed a high rate of response to salvage cranial radiation, especially in those receiving greater than 30 Gy to the whole brain and boost to gross disease. MDPI 2022-10-28 /pmc/articles/PMC9689217/ /pubmed/36354704 http://dx.doi.org/10.3390/curroncol29110644 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Volpini, Matthew E.
Song, Jiheon
Samant, Rajiv
MacDonald, David
Nair, Vimoj J.
Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma
title Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma
title_full Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma
title_fullStr Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma
title_full_unstemmed Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma
title_short Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma
title_sort cranial radiation therapy as salvage in the treatment of relapsed primary cns lymphoma
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689217/
https://www.ncbi.nlm.nih.gov/pubmed/36354704
http://dx.doi.org/10.3390/curroncol29110644
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