Kim Nalee, Lim Do Hoon, Yoon Sang Eun, Kim Seok Jin, Kim Won Seog
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
J Neurooncol. 2021 Sep;154(2):207-217. doi: 10.1007/s11060-021-03815-6. Epub 2021 Jul 31.
We aimed to investigate the role of upfront whole-brain radiation therapy (RT), with a reduced dose of 23.4 Gy, following high-dose methotrexate (HD-MTX) in patients with primary central nervous system lymphoma (PCNSL).
We retrospectively reviewed 185 patients with PCNSL treated with HD-MTX between January 2013 and January 2020; 145 patients underwent no RT and 40 patients underwent upfront RT. Using propensity score matching (PSM) to adjust for clinical factors, 40 patients were selected from each treatment group. Event-free survival (EFS) and overall survival (OS) were compared between treatment groups.
At baseline, patients in the upfront RT group were younger, had higher LDH levels, received less frequent rituximab and stem cell transplantation than those in the no-RT group. Patients in the upfront RT group also showed a lower response rate after initial HD-MTX than those in the no-RT group (73% vs. 88%, p = 0.038). The median follow-up was 25.1 (interquartile range 13.7-43.0) months. Comparable 2-year EFS and OS rates were observed between the upfront RT and no-RT groups (56.6% vs. 53.8%, p = 0.170; and 81.7% vs. 75.3%, p = 0.097, respectively). Upfront RT was related to improved EFS and OS in patients with stable disease or progressive disease after HD-MTX, but not in patients with complete or partial response after HD-MTX. Upfront RT was also an independent predictor of EFS and OS in the PSM cohort. The cumulative incidences of treatment-related neurotoxicity at 3 years were 20.2% and 21.2% in the upfront RT and no-RT groups, respectively (p = 0.630).
Upfront RT with a reduced dose of 23.4 Gy, showed favorable outcomes in patients with stable disease or progressive disease after initial HD-MTX. In addition, upfront RT appears to be an effective treatment for PCNSL when rituximab or stem cell transplantation is not feasible.
我们旨在研究在原发性中枢神经系统淋巴瘤（PCNSL）患者中，大剂量甲氨蝶呤（HD-MTX）治疗后给予23.4 Gy低剂量的 upfront 全脑放射治疗（RT）的作用。
我们回顾性分析了2013年1月至2020年1月期间接受HD-MTX治疗的185例PCNSL患者；145例患者未接受RT，40例患者接受了 upfront RT。使用倾向评分匹配（PSM）来调整临床因素，从每个治疗组中选择40例患者。比较治疗组之间的无事件生存期（EFS）和总生存期（OS）。
在基线时， upfront RT组的患者比未接受RT组的患者更年轻，乳酸脱氢酶（LDH）水平更高，接受利妥昔单抗和干细胞移植的频率更低。 upfront RT组患者在初始HD-MTX治疗后的缓解率也低于未接受RT组（73%对88%，p = 0.038）。中位随访时间为25.1（四分位间距13.7 - 43.0）个月。 upfront RT组和未接受RT组之间观察到相似的2年EFS率和OS率（分别为56.6%对53.8%，p = 0.170；81.7%对75.3%，p = 0.097）。 upfront RT与HD-MTX治疗后疾病稳定或进展的患者的EFS和OS改善相关，但与HD-MTX治疗后完全缓解或部分缓解的患者无关。 upfront RT也是PSM队列中EFS和OS的独立预测因素。 upfront RT组和未接受RT组3年时治疗相关神经毒性的累积发生率分别为20.2%和21.2%（p = 0.630）。
给予23.4 Gy低剂量的 upfront RT，在初始HD-MTX治疗后疾病稳定或进展的患者中显示出良好的结果。此外，当利妥昔单抗或干细胞移植不可行时， upfront RT似乎是PCNSL的一种有效治疗方法。
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