Radiation as an Effective Salvage Therapy for Secondary CNS Lymphoma

Publication date: Available online 6 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Sarah A. Milgrom, Chelsea C. Pinnix, T Linda Chi, Thinh H. Vu, Jillian R. Gunther, Tommy Sheu, Nathan Fowler, Jason R. Westin, Loretta J. Nastoupil, Yasuhiro Oki, Luis E. Fayad, Sattva Neelapu, Maria Alma Rodriguez, Frederick B. Hagemeister, Michelle A. Fanale, Hun J. Lee, Chitra Hosing, Sairah Ahmed, Yago Nieto, Elizabeth J. Shpall, Bouthaina S. Dabaja
We assessed the efficacy of radiation therapy (RT) in the management of secondary central nervous system (CNS) lymphoma. The cohort comprised 44 patients with systemic diffuse large-B cell lymphoma (DLBCL) secondarily involving the brain and/or leptomeninges at initial diagnosis or relapse, who received RT. Twenty-nine patients (66%) were in systemic remission when diagnosed with CNS disease. The overall response rate to RT by magnetic resonance imaging was 88% (42% complete, 46% partial). The median overall survival (OS) after RT initiation was 7 months (95% CI: 4-10 months). The OS curve plateaued at 31% from 2 to 8 years. OS was superior in patients who achieved a complete or partial response to RT, underwent stem cell transplantation (SCT) after RT, and had brain parenchymal (vs. leptomeningeal) disease. Eight cases of CNS disease progression occurred after RT: one involved the brain parenchyma and 7 involved the spine and/or CSF/meninges. We conclude that RT is associated with high response rates and may contribute to long-term OS. Additionally, RT may provide CNS disease control that facilitates successful salvage with SCT in patients with chemorefractory disease.

Teaser

We reviewed the outcomes of patients with secondary central nervous system involvement by diffuse large-B cell lymphoma, who were treated with radiation therapy (RT) at a single institution. RT was associated with high rates of radiographic disease response and local control. Overall survival was superior in patients who achieved a complete or partial response to RT, who underwent autologous stem cell transplantation after RT, and who had brain parenchymal (vs. leptomeningeal) disease.


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