Whole brain radiotherapy improves survival outcomes in primary CNS lymphoma patients ineligible for systemic therapy
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ORIGINAL ARTICLE
Whole brain radiotherapy improves survival outcomes in primary CNS lymphoma patients ineligible for systemic therapy Jiheon Song 1 & Rajiv Samant 1 & Mohammad Jay 2 & Hina Chaudry 3 & Xin Yan Fan 4 & David MacDonald 5 & Isabelle Bence-Bruckler 5 & Vimoj Nair 1 Received: 19 October 2019 / Accepted: 24 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Primary central nervous system lymphoma (PCNSL) is a very rare type of malignancy with a poor prognosis. The role of whole brain radiotherapy (WBRT) in PCNSL has been questioned due to the significant neurotoxicity and lack of convincing data for survival benefit. Even its role in a palliative setting remains to be clearly elucidated. Our study aims to investigate the benefit of WBRT in patients who are ineligible for systemic therapy. Methods A single-institution retrospective study was conducted on patients diagnosed with PCNSL between 2002 and 2017. Patients were excluded if they received systemic therapy or focal radiation only. Data on patient demographics and WBRT were collected and correlated with clinical outcomes. Results A total of 48 patients were selected for analysis, among which 31 (64.6%) patients received WBRT and 17 (35.4%) patients received supportive care only. Patient baseline characteristics were similar between the two groups. Median overall survival (OS) was 4.3 months among the entire cohort. WBRT was associated with improved median OS (8.0 months, range 1.4– 62.3 months) compared with supportive care only (3.3 months, range 0.7–18.3 months) (HR 0.39, 95% CI 0.20–0.75, p = 0.005). Among patients who received WBRT, higher radiation dose to the whole brain was not associated with survival (p = 0.10), but higher radiation dose to the gross tumor was associated with improved survival (p = 0.007). Conclusion Patients with PCNSL who are ineligible for systemic therapy may still benefit from WBRT with improvement in survival, compared with the best supportive care. Dose escalation through the addition of a gross tumor boost in these patients was associated with improved overall survival. Further studies in the prospective setting are necessary to confirm the findings from the study. Keywords Palliative radiotherapy . Primary central nervous system lymphoma . Radiation oncology . Whole brain radiotherapy
Introduction Presented in part at the Annual Scientific Meeting of the 2019 Canadian Association of Radiation Oncology (CARO), October 2019, Halifax, NS. * Jiheon Song [email protected] 1
Division of Radiation Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
2
Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
3
Ottawa Hospital Research Institute, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada
4
Division of Family Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
5
Division of Hematology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
Primary cen
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