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. 2022 Jan;156(2):307-316. doi: 10.1007/s11060-021-03909-1. Epub 2021 Dec 1.
To date, there is no relevant data supporting the role of salvage radiotherapy (sRT) in patients with refractory or relapsed primary central nervous system lymphoma (PCNSL). Herein, we aimed to investigate the impact of sRT in patients with refractory or relapsed PCNSL following upfront HD-MTX.
We retrospectively reviewed 89 patients who had refractory (n = 16) or recurrent disease after an initial favorable response (n = 73); among them, 41 were treated with sRT and 48 were treated without sRT (nRT). Event-free survival (rEFS) and overall survival (rOS) after first recurrence were considered from the date of recurrence to date of each event.
Overall, the first failure was diagnosed at a median of 11.0 months [interquartile range (IQR), 5.6-26.4] after first treatment. More than half of the patients had recurrent disease involving initial tumor bed (n = 47), deep structure (n = 67), and multiple lesions (n = 58). Among 19 patients who were initially treated with 23.4 Gy of whole brain RT, 10 patients received sRT as a re-irradiation; other 31 patients in sRT group were RT naïve patients. There was no significant difference in tumor characteristics between sRT and nRT group. Overall and complete response after salvage treatment were 80% and 48%, respectively; sRT provided higher overall response rate than nRT (93% vs. 69%, p = 0.011). With a median follow-up of 14.3 months (IQR, 7.9-31.4), 2-year rEFS and rOS rates were 27% and 57%, respectively. There were no differences in rEFS and rOS according to sRT (sRT vs. nRT, 26% vs. 28%, p = 0.730; 63% vs. 50%, p = 0.690). Poor performance, recurrence interval < 8 months, and unfavorable response following salvage treatment were associated with inferior rEFS and rOS. Additionally, sRT and stem cell transplantation improved response rate independently after multivariate analysis for complete/partial response.
We found favorable response rate and comparable survival outcomes following sRT compared with non-local treatments for patients with refractory/relapsed PCNSL. Further studies of patient selection could stratify patients who can benefit from sRT.
迄今为止，尚无相关数据支持挽救性放疗（sRT）在原发性中枢神经系统淋巴瘤（PCNSL）复发/难治患者中的作用。本研究旨在探讨 upfront HD-MTX 后复发/难治性 PCNSL 患者接受 sRT 的影响。
我们回顾性分析了 89 例初始治疗后发生难治性（n=16）或复发（n=73）疾病的患者；其中 41 例接受 sRT，48 例未接受 sRT（nRT）。首次复发后的无事件生存（rEFS）和总生存（rOS）分别从复发日期计算至每个事件的日期。
总体而言，首次失败发生在首次治疗后 11.0 个月（中位数[四分位距（IQR）]，5.6-26.4）。超过一半的患者出现初始肿瘤床（n=47）、深部结构（n=67）和多处病变（n=58）复发。在接受 23.4 Gy 全脑 RT 初始治疗的 19 例患者中，有 10 例接受了 sRT 再放疗；sRT 组的其他 31 例患者为 RT 初治患者。sRT 组与 nRT 组的肿瘤特征无显著差异。挽救治疗后的总缓解率和完全缓解率分别为 80%和 48%；sRT 组的总缓解率高于 nRT 组（93% vs. 69%，p=0.011）。中位随访时间为 14.3 个月（IQR，7.9-31.4），2 年 rEFS 和 rOS 率分别为 27%和 57%。sRT 与 nRT 之间 rEFS 和 rOS 无差异（sRT 组 vs. nRT 组，26% vs. 28%，p=0.730；63% vs. 50%，p=0.690）。较差的表现、复发间隔<8 个月和挽救治疗后不良反应与 rEFS 和 rOS 不良相关。此外，多因素分析显示，sRT 和干细胞移植可独立改善完全/部分缓解率。
与非局部治疗相比，我们发现 sRT 可使复发/难治性 PCNSL 患者获得良好的缓解率和生存结局。进一步的患者选择研究可能会分层受益于 sRT 的患者。
