N B Khimani1, A K Ng2, Y H Chen3, P Catalano3, B Silver4, P M Mauch4. 1. Department of Radiation Oncology, Brigham & Women's Hospital and Dana-Farber Cancer Institute; Harvard Medical School. 2. Department of Radiation Oncology, Brigham & Women's Hospital and Dana-Farber Cancer Institute. Electronic address: ang@lroc.harvard.edu. 3. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA. 4. Department of Radiation Oncology, Brigham & Women's Hospital and Dana-Farber Cancer Institute.
Abstract
BACKGROUND: To assess the efficacy of salvage radiation therapy (RT) in patients with recurrent/refractory primary or secondary central nervous system lymphoma (CNSL) after initial methotrexate (MTX)-based chemotherapy and to identify factors associated with treatment outcome. PATIENTS AND METHODS: We reviewed 36 patients with primary or secondary CNSL who relapsed after MTX therapy and received salvage RT. Primary end points were radiographic response and overall survival (OS). RESULTS: After salvage RT, 18 patients (50%) achieved a complete radiographic response and 6 (17%) achieved a partial response, for an overall response rate of 67% [95% confidence interval (CI) 49% to 81%]. The median OS from start of salvage RT was 11.7 months (range: 0.6-94.7). Patients treated with less than five cycles of MTX before failure had a significantly shorter OS than patients who received five or more cycles (9.2 months versus not reached, P = 0.04). Patients with CNSL limited to brain only had a significantly longer OS than patients with disease in the brain and other central nervous system locations (16.5 versus 4.5 months, P=0.01). CONCLUSION: Salvage RT is effective for patients with recurrent/refractory primary or secondary CNSL after initial MTX therapy. Having received five or more cycles of MTX before failure and CNSL limited to the brain at relapse are associated with longer OS.
BACKGROUND: To assess the efficacy of salvage radiation therapy (RT) in patients with recurrent/refractory primary or secondary central nervous system lymphoma (CNSL) after initial methotrexate (MTX)-based chemotherapy and to identify factors associated with treatment outcome. PATIENTS AND METHODS: We reviewed 36 patients with primary or secondary CNSL who relapsed after MTX therapy and received salvage RT. Primary end points were radiographic response and overall survival (OS). RESULTS: After salvage RT, 18 patients (50%) achieved a complete radiographic response and 6 (17%) achieved a partial response, for an overall response rate of 67% [95% confidence interval (CI) 49% to 81%]. The median OS from start of salvage RT was 11.7 months (range: 0.6-94.7). Patients treated with less than five cycles of MTX before failure had a significantly shorter OS than patients who received five or more cycles (9.2 months versus not reached, P = 0.04). Patients with CNSL limited to brain only had a significantly longer OS than patients with disease in the brain and other central nervous system locations (16.5 versus 4.5 months, P=0.01). CONCLUSION: Salvage RT is effective for patients with recurrent/refractory primary or secondary CNSL after initial MTX therapy. Having received five or more cycles of MTX before failure and CNSL limited to the brain at relapse are associated with longer OS.
Authors: Jorg Dietrich; Laura Versmee; Jan Drappatz; April F Eichler; Lakshmi Nayak; Andrew Norden; Eric Wong; Michelle R Pisapia; SooAe S Jones; Amanda B Gordon; Bruce A Chabner; Fred Hochberg; Tracy T Batchelor Journal: Oncologist Date: 2020-07-01
Authors: Tugce Kutuk; G Daniel Grass; Daniel Oliver; Sepideh Mokhtari; Solmaz Sahebjam; Sungjune Kim; Jose Penagaricano; Hsiang-Hsuan Michael Yu; Nam Tran; Arnold Etame; Jennifer L Peterson; Peter Forsyth; Timothy Robinson Journal: Adv Radiat Oncol Date: 2022-03-09