Response-adapted radiation therapy for newly diagnosed primary diffuse large B-cell lymphoma of the CNS treated with methotrexate-based systemic therapy

Tommy Sheu, MD; Sarah A. Milgrom, MD; Therese Y. Andraos, MD; Jillian R. Gunther, MD, PhD; Linda Chi, MD; Loretta Nastoupil, MD; Nathan Fowler, MD; Yasuhiro Oki, MD; Michelle A. Fanale, MD; Luis E. Fayad, MD; Fredrick Hagemeister, MD; Sattva S. Neelapu, MD; L. Jeffrey Medeiros, MD; Chitra Hosing, MD; Yago Nieto, MD, PhD; Sairah Ahmed, MD; Amin M. Alousi, MD; Bouthaina Dabaja, MD; Chelsea C. Pinnix, MD, PhD

Advances in Radiation Oncology (Oct 2018)

Response-adapted radiation therapy for newly diagnosed primary diffuse large B-cell lymphoma of the CNS treated with methotrexate-based systemic therapy

Tommy Sheu, MD,
Sarah A. Milgrom, MD,
Therese Y. Andraos, MD,
Jillian R. Gunther, MD, PhD,
Linda Chi, MD,
Loretta Nastoupil, MD,
Nathan Fowler, MD,
Yasuhiro Oki, MD,
Michelle A. Fanale, MD,
Luis E. Fayad, MD,
Fredrick Hagemeister, MD,
Sattva S. Neelapu, MD,
L. Jeffrey Medeiros, MD,
Chitra Hosing, MD,
Yago Nieto, MD, PhD,
Sairah Ahmed, MD,
Amin M. Alousi, MD,
Bouthaina Dabaja, MD,
Chelsea C. Pinnix, MD, PhD

Affiliations

Tommy Sheu, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Sarah A. Milgrom, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Therese Y. Andraos, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Jillian R. Gunther, MD, PhD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Linda Chi, MD: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Loretta Nastoupil, MD: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Nathan Fowler, MD: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Yasuhiro Oki, MD: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Michelle A. Fanale, MD: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Luis E. Fayad, MD: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Fredrick Hagemeister, MD: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
Sattva S. Neelapu, MD: Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
L. Jeffrey Medeiros, MD: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Chitra Hosing, MD: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
Yago Nieto, MD, PhD: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
Sairah Ahmed, MD: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
Amin M. Alousi, MD: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
Bouthaina Dabaja, MD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Chelsea C. Pinnix, MD, PhD: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Corresponding author. Department of Radiation Oncology, Unit 97, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030 USA.

Journal volume & issue: Vol. 3, no. 4
pp. 639 – 646

Abstract

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Background: For patients with primary diffuse large B-cell lymphoma of the central nervous system (PCNSL), whole-brain radiation therapy (WBRT) to doses of ≥45 Gy are often given after a partial response (PR) to methotrexate-based induction chemotherapy. We conducted an exploratory analysis to determine whether lower-dose WBRT, given with a boost to sites of persistent disease, might be a reasonable alternative. Methods and materials: We retrospectively reviewed the records of 22 patients with PCNSL who received WBRT, with or without a boost, after methotrexate-based induction chemotherapy. Outcomes were compared among patients according to response to chemotherapy using the Kaplan-Meier method. Results: Median follow-up was 52 months. All patients with a complete response (CR) (n = 5) received WBRT to 23.4 Gy. One CR patient died after an in-field relapse. Patients with partial response (PR) (n = 10) received a median whole-brain dose of 23.4 Gy with (n = 8) or without (n = 2) a boost; there were 2 relapses within the central nervous system (CNS). All PR patients were alive at the time of analysis. The overall survival (P = .127) and freedom from relapse within the CNS (P = .967) were not different for patients with CR versus PR. Baseline and follow-up neurocognitive evaluations were available for 4 PR patients, and there were no significant differences between pre- and post-treatment evaluations (P > .05 for language, memory, visual-spatial, attention, or motor functions). All patients who progressed or did not respond to chemotherapy and then received WBRT had died at a median time of 3.4 months. Patients who progressed or did not respond to chemotherapy had worse overall survival (P = .001) and freedom from CNS relapse (P = .005) compared with CR patients. Conclusions: Among patients with a PR to induction chemotherapy, reduced-dose WBRT with a boost to residual PCNSL may be a viable treatment approach that merits further investigation.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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