Emeline Tabouret1,2,3, Caroline Houillier3, Nadine Martin-Duverneuil4, Marie Blonski5, Carole Soussain6, Herve Ghesquières7, Roch Houot8, Delphine Larrieu9, Pierre Soubeyran10, Remy Gressin11, Emmanuel Gyan12, Olivier Chinot1,2, Luc Taillandier5, Sylvain Choquet13, Agusti Alentorn3,14, Delphine Leclercq4, Antonio Omuro15, Marie-Laure Tanguy16, Khe Hoang-Xuan3. 1. APHM, service de Neuro-Oncologie, CHU Timone, Marseille, France. 2. Aix-Marseille Universite, UMR911, Marseille, France. 3. APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. 4. Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. 5. Service de Neurologie, Centre Hospitalier de Nancy, Nancy, France. 6. Service d'Hématologie, Institut Curie-René Huguenin, Saint-Cloud, France. 7. Department of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France. 8. Service d'Hématologie Clinique, CHU-Hôpital Pontchaillou de Rennes, Rennes, France. 9. Service de Neuro-Oncologie, CHU de Poitiers, Poitiers, France. 10. Service d'Hématologie, Institut Bergonie, Bordeaux, France. 11. Hématologie Clinique, Hôpital A Michallon, Grenoble, France. 12. Service d'Hématologie Clinique de Tours, Tours, France. 13. Service d'Hématologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. 14. UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France. 15. Memorial Sloan-Kettering Cancer Center, New York, New York, USA. 16. Service de biostatistiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Abstract
Background: Our aim was to review MRI characteristics of patients with primary CNS lymphoma (PCNSL) enrolled in a randomized phase II trial and to evaluate their potential prognostic value and patterns of relapse, including T2 fluid attenuated inversion recovery (FLAIR) MRI abnormalities. Methods: Neuroimaging findings in 85 patients with PCNSL enrolled in a prospective trial were reviewed blinded to outcomes. MRI characteristics and responses according to International PCNSL Collaborative Group (IPCG) criteria were correlated with progression-free survival (PFS) and overall survival (OS). Results: Multivariate analysis showed that objective response at 2 months (P < .001) and at end of treatment (P = .015) were predictors of prolonged OS. Infratentorial location (P = .008) and large (>11.4 cm3) enhancing tumor volume (P = .006) were associated with poor OS and PFS, respectively. Ratio of change in product of largest diameters at early MRI evaluation but not timing of complete response achievement (early vs delayed) was prognostic for OS. Sixty-nine patients relapsed. Relapse in the brain (n = 52) involved an initial enhancing site, a different site, or both in 46%, 40%, and 14% of patients, respectively. At baseline, non-enhancing T2-FLAIR hypersignal lesions distant from the enhancing tumor site were detected in 18 patients. These lesions markedly decreased (>50%) in 16 patients after chemotherapy, supporting their neoplastic nature. Of these patients, 10/18 relapsed, half (n = 5) in the initially non-enhancing T2-FLAIR lesions. Conclusions: Baseline tumor size and infratentorial localization are of prognostic value in PCNSL. Our findings provide evidence that non-enhancing FLAIR abnormalities may add to overall tumor burden, suggesting that response criteria should be refined to incorporate evaluation of T2-weighted/FLAIR sequences.
RCT Entities:
Background: Our aim was to review MRI characteristics of patients with primary CNS lymphoma (PCNSL) enrolled in a randomized phase II trial and to evaluate their potential prognostic value and patterns of relapse, including T2 fluid attenuated inversion recovery (FLAIR) MRI abnormalities. Methods: Neuroimaging findings in 85 patients with PCNSL enrolled in a prospective trial were reviewed blinded to outcomes. MRI characteristics and responses according to International PCNSL Collaborative Group (IPCG) criteria were correlated with progression-free survival (PFS) and overall survival (OS). Results: Multivariate analysis showed that objective response at 2 months (P < .001) and at end of treatment (P = .015) were predictors of prolonged OS. Infratentorial location (P = .008) and large (>11.4 cm3) enhancing tumor volume (P = .006) were associated with poor OS and PFS, respectively. Ratio of change in product of largest diameters at early MRI evaluation but not timing of complete response achievement (early vs delayed) was prognostic for OS. Sixty-nine patients relapsed. Relapse in the brain (n = 52) involved an initial enhancing site, a different site, or both in 46%, 40%, and 14% of patients, respectively. At baseline, non-enhancing T2-FLAIR hypersignal lesions distant from the enhancing tumor site were detected in 18 patients. These lesions markedly decreased (>50%) in 16 patients after chemotherapy, supporting their neoplastic nature. Of these patients, 10/18 relapsed, half (n = 5) in the initially non-enhancing T2-FLAIR lesions. Conclusions: Baseline tumor size and infratentorial localization are of prognostic value in PCNSL. Our findings provide evidence that non-enhancing FLAIR abnormalities may add to overall tumor burden, suggesting that response criteria should be refined to incorporate evaluation of T2-weighted/FLAIR sequences.
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