Role of 23.4 Gy upfront whole-brain radiation therapy following high-dose methotrexate for primary central nervous system lymphoma: a comparative analysis of whole-brain radiation therapy versus no radiation therapy (Jul, 10.1007/s11060-021-03815-6, 2021)

被引：1

作者：

Kim, Nalee ^{[1
]}

Lim, Do Hoon ^{[1
]}

Yoon, Sang Eun ^{[2
]}

Kim, Seok Jin ^{[2
]}

Kim, Won Seog ^{[2
]}

机构：

[1] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Radiat Oncol, 81 Irwon Ro, Seoul 06351, South Korea

[2] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Med, 81 Irwon Ro, Seoul 06351, South Korea

来源：

JOURNAL OF NEURO-ONCOLOGY | 2021年 / 154卷 / 02期

关键词：

Central nervous system; Lymphoma; Methotrexate; Radiation therapy;

D O I：

10.1007/s11060-021-03824-5

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Introduction: We aimed to investigate the role of upfront whole-brain radiation therapy (RT), with a reduced dose of 23.4 Gy, following high-dose methotrexate (HD-MTX) in patients with primary central nervous system lymphoma (PCNSL). Methods: We retrospectively reviewed 185 patients with PCNSL treated with HD-MTX between January 2013 and January 2020; 145 patients underwent no RT and 40 patients underwent upfront RT. Using propensity score matching (PSM) to adjust for clinical factors, 40 patients were selected from each treatment group. Event-free survival (EFS) and overall survival (OS) were compared between treatment groups. Results: At baseline, patients in the upfront RT group were younger, had higher LDH levels, received less frequent rituximab and stem cell transplantation than those in the no-RT group. Patients in the upfront RT group also showed a lower response rate after initial HD-MTX than those in the no-RT group (73% vs. 88%, p = 0.038). The median follow-up was 25.1 (interquartile range 13.7–43.0) months. Comparable 2-year EFS and OS rates were observed between the upfront RT and no-RT groups (56.6% vs. 53.8%, p = 0.170; and 81.7% vs. 75.3%, p = 0.097, respectively). Upfront RT was related to improved EFS and OS in patients with stable disease or progressive disease after HD-MTX, but not in patients with complete or partial response after HD-MTX. Upfront RT was also an independent predictor of EFS and OS in the PSM cohort. The cumulative incidences of treatment-related neurotoxicity at 3 years were 20.2% and 21.2% in the upfront RT and no-RT groups, respectively (p = 0.630). Conclusions: Upfront RT with a reduced dose of 23.4 Gy, showed favorable outcomes in patients with stable disease or progressive disease after initial HD-MTX. In addition, upfront RT appears to be an effective treatment for PCNSL when rituximab or stem cell transplantation is not feasible. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

引用

页码：219 / 219

页数：1