Fossard Gaëlle, Ferlay Céline, Nicolas-Virelizier Emmanuelle, Rey Philippe, Ducray François, Jouanneau Emmanuel, Faurie Pierre, Belhabri Amine, Sunyack Marie-Pierre, Chassagne-Clément Catherine, Thiesse Philippe, Sebban Catherine, Biron Pierre, Blay Jean-Yves, Ghesquières Hervé
Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
Centre Léon Bérard, Department of Statistics, Université Claude Bernard Lyon 1, Lyon, France.
Eur J Cancer. 2017 Feb;72:12-19. doi: 10.1016/j.ejca.2016.10.036. Epub 2016 Dec 22.
The optimal follow-up strategy for primary central nervous system lymphoma (PCNSL) patients after first-line therapy is unclear. The goal of this study is to determine the utility of planned brain surveillance imaging in the detection of relapse in a retrospective cohort of PCNSL patients.
Patients were consecutive PCNSL cases treated in Leon Berard Cancer Centre, Lyon, France, from 1985 to 2011. Histology was diffuse large B-cell lymphoma in 94%. Patients were treated by methotrexate (92%) and cytarabine (63%) based-chemotherapy followed by radiotherapy for 108 patients (51%). Clinical records were reviewed for details at relapse and relationship to planned imaging. The imaging follow-up strategy was performed according to each treating physicians.
Among 209 PCNSL patients, 127 complete response patients entered in post-treatment observation and 63 (50%) subsequently relapsed. Among the 125 evaluable patients, the majority of relapses (N = 49, 80%) was asymptomatic and identified before the planned brain imaging. Surveillance imaging detected relapses before symptoms in 12 patients who entered in post-therapy observation (10%). The median number of brain imaging during the follow-up was 7 (0-13). A total of 819 MRI/CT-scan were performed leading to the detection of 12 asymptomatic relapses. The one year OS rates were 41% and 58% for symptomatic and non-symptomatic relapses, respectively (P = 0.21).
The majority of PCNSL relapses occurred outside planned follow-up with no difference in patient outcome between symptomatic and asymptomatic relapses. The role of brain imaging for the detection of relapses in the follow-up of PCNSL patients remains to be clarified.
一线治疗后原发性中枢神经系统淋巴瘤（PCNSL）患者的最佳随访策略尚不清楚。本研究的目的是确定在一组PCNSL患者回顾性队列中，计划的脑部监测成像在检测复发中的效用。
患者为1985年至2011年在法国里昂莱昂·贝拉尔癌症中心接受治疗的连续性PCNSL病例。94%的组织学类型为弥漫性大B细胞淋巴瘤。患者接受基于甲氨蝶呤（92%）和阿糖胞苷（63%）的化疗，随后108例患者（51%）接受放疗。复查临床记录以了解复发时的详细情况以及与计划成像的关系。成像随访策略由每位治疗医生实施。
在209例PCNSL患者中，127例完全缓解患者进入治疗后观察期，其中63例（50%）随后复发。在125例可评估患者中，大多数复发（N = 49，80%）无症状，且在计划的脑部成像之前被发现。监测成像在进入治疗后观察期的12例患者（10%）中在出现症状之前检测到复发。随访期间脑部成像的中位数为7次（0 - 13次）。共进行了819次MRI/CT扫描，检测到12例无症状复发。有症状和无症状复发患者的一年总生存率分别为41%和58%（P = 0.21）。
大多数PCNSL复发发生在计划的随访之外，有症状和无症状复发患者的预后无差异。脑部成像在PCNSL患者随访中检测复发的作用仍有待阐明。
