Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2017 Mar 1;19(3):422-429.
doi: 10.1093/neuonc/now238.

Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial

Emeline Tabouret  1   2   3 , Caroline Houillier  3 , Nadine Martin-Duverneuil  4 , Marie Blonski  5 , Carole Soussain  6 , Herve Ghesquières  7 , Roch Houot  8 , Delphine Larrieu  9 , Pierre Soubeyran  10 , Remy Gressin  11 , Emmanuel Gyan  12 , Olivier Chinot  1   2 , Luc Taillandier  5 , Sylvain Choquet  13 , Agusti Alentorn  3   14 , Delphine Leclercq  4 , Antonio Omuro  15 , Marie-Laure Tanguy  16 , Khe Hoang-Xuan  3
Affiliations
Clinical Trial

Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial

Emeline Tabouret et al. Neuro Oncol. .

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.

Keywords: T2-weighted/FLAIR sequences; magnetic resonance imaging; primary CNS lymphoma; prognostic factor; response criteria.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Progression-free survival and OS according to the T1 enhancement volume and posterior fossa involvement.
Fig. 2
Fig. 2
Distant FLAIR involvement without T1 post-gadolinium enhancement. (A) Initial T1-weighted image with gadolinium injection. (B) Initial FLAIR image with non-enhancing lesions. (C) FLAIR image evaluation at the end of the treatment; marked response of the initial FLAIR lesions.
See this image and copyright information in PMC

Comment in

References

    1. Hoang-Xuan K, Bessell E, Bromberg J, et al. European Association for Neuro-Oncology Task Force on Primary CNS Lymphoma. Diagnosis and treatment of primary CNS lymphoma in immunocompetent patients: guidelines from the European Association for Neuro-Oncology. Lancet Oncol. 2015;16(7):e322–e332. - PubMed
    1. Coulon A, Lafitte F, Hoang-Xuan K, et al. Radiographic findings in 37 cases of primary CNS lymphoma in immunocompetent patients. Eur Radiol. 2002;12(2):329–340. - PubMed
    1. Küker W, Nägele T, Korfel A, et al. Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients. J Neurooncol. 2005;72(2):169–177. - PubMed
    1. Partovi S, Karimi S, Lyo JK, et al. Multimodality imaging of primary CNS lymphoma in immunocompetent patients. Br J Radiol. 2014;87(1036):20130684. - PMC - PubMed
    1. Tang YZ, Booth TC, Bhogal P, et al. Imaging of primary central nervous system lymphoma. Clin Radiol. 2011;66(8):768–777. - PubMed

Publication types

MeSH terms