Division of Radiation Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
Support Care Cancer. 2020 Nov;28(11):5363-5369. doi: 10.1007/s00520-020-05376-2. Epub 2020 Mar 5.
Primary central nervous system lymphoma (PCNSL) is a very rare type of malignancy with a poor prognosis. The role of whole brain radiotherapy (WBRT) in PCNSL has been questioned due to the significant neurotoxicity and lack of convincing data for survival benefit. Even its role in a palliative setting remains to be clearly elucidated. Our study aims to investigate the benefit of WBRT in patients who are ineligible for systemic therapy.
A single-institution retrospective study was conducted on patients diagnosed with PCNSL between 2002 and 2017. Patients were excluded if they received systemic therapy or focal radiation only. Data on patient demographics and WBRT were collected and correlated with clinical outcomes.
A total of 48 patients were selected for analysis, among which 31 (64.6%) patients received WBRT and 17 (35.4%) patients received supportive care only. Patient baseline characteristics were similar between the two groups. Median overall survival (OS) was 4.3 months among the entire cohort. WBRT was associated with improved median OS (8.0 months, range 1.4-62.3 months) compared with supportive care only (3.3 months, range 0.7-18.3 months) (HR 0.39, 95% CI 0.20-0.75, p = 0.005). Among patients who received WBRT, higher radiation dose to the whole brain was not associated with survival (p = 0.10), but higher radiation dose to the gross tumor was associated with improved survival (p = 0.007).
Patients with PCNSL who are ineligible for systemic therapy may still benefit from WBRT with improvement in survival, compared with the best supportive care. Dose escalation through the addition of a gross tumor boost in these patients was associated with improved overall survival. Further studies in the prospective setting are necessary to confirm the findings from the study.
原发性中枢神经系统淋巴瘤（PCNSL）是一种非常罕见的恶性肿瘤，预后较差。由于全脑放疗（WBRT）会导致严重的神经毒性，且生存获益方面的数据缺乏说服力，其在 PCNSL 中的作用受到质疑。即使在姑息治疗的情况下，WBRT 的作用也仍需要进一步阐明。我们的研究旨在探讨 WBRT 在不适合全身治疗的患者中的获益。
对 2002 年至 2017 年间诊断为 PCNSL 的患者进行了单机构回顾性研究。如果患者仅接受全身治疗或局部放疗，则将其排除在外。收集了患者的人口统计学和 WBRT 数据，并与临床结果相关联。
共选择了 48 例患者进行分析，其中 31 例（64.6%）患者接受了 WBRT，17 例（35.4%）患者仅接受了支持性治疗。两组患者的基线特征相似。整个队列的中位总生存期（OS）为 4.3 个月。与仅接受支持性治疗的患者（3.3 个月，范围 0.7-18.3 个月）相比，接受 WBRT 的患者中位 OS 更长（8.0 个月，范围 1.4-62.3 个月）（HR 0.39，95%CI 0.20-0.75，p=0.005）。在接受 WBRT 的患者中，全脑较高的放疗剂量与生存无关（p=0.10），但肿瘤大体的较高放疗剂量与生存改善相关（p=0.007）。
与最佳支持治疗相比，不适合全身治疗的 PCNSL 患者仍可从 WBRT 中获益，改善生存。在这些患者中，通过增加大体肿瘤加量放疗可以提高总体生存率。需要在前瞻性研究中进一步研究，以确认本研究的结果。
