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. 2022 Oct 28;29(11):8160-8170.
doi: 10.3390/curroncol29110644.

Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma

Matthew E Volpini  1 , Jiheon Song  1 , Rajiv Samant  1 , David MacDonald  2 , Vimoj J Nair  1
Affiliations

Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma

Matthew E Volpini et al. Curr Oncol. .

Abstract

Primary central nervous system lymphoma (PCNSL) is a rare malignancy. Standard of care is upfront high-dose methotrexate (HD-MTX) chemotherapy, while cranial radiation is more commonly used in the salvage setting. In this retrospective study, we aimed to investigate the safety and efficacy of salvage cranial radiation in PCNSL. PCNSL patients who received upfront HD-MTX chemotherapy and salvage cranial radiation after treatment failure between 1995 and 2018 were selected. Radiological response to cranial radiation was assessed as per Response Assessment in Neuro-Oncology Criteria. Twenty one patients were selected (median age 59.9 years), with median follow-up of 19.9 months. Fourteen patients (66.7%) received a boost to the gross tumour volume (GTV). Four patients (19.0%) sustained grade ≥2 treatment-related neurotoxicity post-completion of cranial radiation. Of the 19 patients who had requisite MRI with gadolinium imaging available for Response Assessment in Neuro-Oncology (RANO) criteria assessment, 47.4% achieved complete response, 47.4% achieved partial response, and 5.3% of patients exhibited stable disease. Higher dose to the whole brain (>30 Gy) was associated with higher rate of complete response (63.6%) than lower dose (≤30 Gy, 37.5%), while boost dose to the gross disease was also associated with higher rate of complete response (61.5%) compared with no boost dose (33.3%). Median overall survival was 20.0 months. PCNSL patients who relapsed following upfront chemotherapy showed a high rate of response to salvage cranial radiation, especially in those receiving greater than 30 Gy to the whole brain and boost to gross disease.

Keywords: cranial radiation therapy; primary CNS lymphoma; salvage radiation therapy; whole brain radiation therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for patient selection. PCNSL: primary central nervous system lymphoma. HD-MTX: High-dose methotrexate.
Figure 2
Figure 2
Response rates as per RANO criteria. RANO = Response Assessment in Neuro-Oncology. CR = complete response. PR = partial response. Stable = stable disease.
Figure 3
Figure 3
Kaplan–Meier survival curves for patients treated with cranial radiation therapy. Median overall survival (OS): 20.0 months (range 0.9 to 143.6 months). Median progression-free survival (PFS): 14.1 months (0.9 to 111.4 months).
Figure 4
Figure 4
Median OS by WBRT dose (Left), and the implementation of a boost to gross disease (Right). WBRT dose >30 Gy was associated with marked increase in median OS = overall survival.
See this image and copyright information in PMC

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