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Reduced-dose whole-brain radiotherapy with tumor bed boost after upfront high-dose methotrexate for primary central nervous system lymphoma

Radiation Oncology Journal 2020년 38권 1호 p.35 ~ 43
Lee Tae-Hoon, 이주호, 장지현, 예성준, 김태민, 박철기, 김일한, 김병혁, 위찬우,
소속 상세정보
 ( Lee Tae-Hoon ) - Seoul National University College of Medicine Seoul National University Hospital Department of Radiation Oncology
이주호 ( Lee Joo-Ho ) - Seoul National University College of Medicine Seoul National University Hospital Department of Radiation Oncology
장지현 ( Chang Ji-Hyun ) - Seoul National University College of Medicine Seoul National University Hospital Department of Radiation Oncology
예성준 ( Ye Sung-Joon ) - Seoul National University College of Medicine Seoul National University Hospital Department of Radiation Oncology
김태민 ( Kim Tae-MIn ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
박철기 ( Park Chul-Kee ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
김일한 ( Kim Il-Han ) - Seoul National University College of Medicine Seoul National University Hospital Department of Radiation Oncology
김병혁 ( Kim Byoung-Hyuck ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Radiation Oncology
위찬우 ( Wee Chan-Woo ) - Seoul Metropolitan Government-Seoul National University Boramae Medical Center Department of Radiation Oncology

Abstract


Purpose: This retrospective study compares higher-dose whole-brain radiotherapy (hdWBRT) with reduced-dose WBRT (rdWBRT) in terms of clinical efficacy and toxicity profile in patients treated for primary central nervous system lymphoma (PCNSL).

Materials and Methods: Radiotherapy followed by high-dose methotrexate (HD-MTX)-based chemotherapy was administered to immunocompetent patients with histologically confirmed PCNSL between 2000 and 2016. Response to chemotherapy was taken into account when prescribing the radiation dose to the whole brain and primary tumor bed. The whole brain dose was ≤23.4 Gy for rdWBRT (n = 20) and >23.4 Gy for hdWBRT (n = 68). Patients manifesting cognitive disturbance, memory impairment and dysarthria were considered to have neurotoxicity. A median follow-up was 3.62 years.

Results: The 3-year overall survival (OS) and progression-free survival (PFS) were 70.0% and 48.9% with rdWBRT, and 63.2% and 43.2% with hdWBRT. The 3-year OS and PFS among patients with partial response (n = 45) after chemotherapy were 77.8% and 53.3% with rdWBRT, and 58.3% and 45.8% with hdWBRT (p > 0.05). Among patients with complete response achieved during follow-up, the 3-year freedom from neurotoxicity (FFNT) rate was 94.1% with rdWBRT and 62.4% with hdWBRT. Among patients aged ≥60 years, the 3-year FFNT rate was 87.5% with rdWBRT and 39.1% with hdWBRT (p = 0.49). Neurotoxicity was not observed after rdWBRT in patients aged below 60 years.

Conclusion: rdWBRT with tumor bed boost combined with upfront HD-MTX is less neurotoxic and results in effective survival as higher-dose radiotherapy even in partial response after chemotherapy.

키워드

Non-Hodgkin lymphoma; Central nervous system; Cranial irradiation; Adverse effects

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