Craniospinal irradiation prior to stem cell transplant for hematologic malignancies with CNS involvement: Effectiveness and toxicity after photon or proton treatment

Gunther, Jillian R.; Rahman, Ahmad R.; Dong, Wenli; Yehia, Zeinab Abou; Kebriaei, Partow; Rondón, Gabriela; Pinnix, Chelsea C.; Milgrom, Sarah A.; Allen, Pamela K.; Dabaja, Bouthaina S.; Smith, Grace L.

doi:10.1016/j.prro.2017.05.002

Cited by 25 publications

(10 citation statements)

References 39 publications

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“…The role of cranial craniospinal radiotherapy has become controversial because of its neurologic adverse events. However, recent studies state that IT and high-dose chemotherapy are enough to prevent CNS leukemia (240)(241)(242)(243).…”

Section: Therapeutic Option For Cns Leukemiamentioning

confidence: 99%

A narrative review of central nervous system involvement in acute leukemias

Deak¹,

Gorcea-Andronic²,

Sas³

et al. 2021

Ann Transl Med

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Acute leukemias (both myeloid and lymphoblastic) are a group of diseases for which each year more successful therapies are implemented. However, in a subset of cases the overall survival (OS) is still exceptionally low due to the infiltration of leukemic cells in the central nervous system (CNS) and the subsequent formation of brain tumors. The CNS involvement is more common in acute lymphocytic leukemia (ALL), than in adult acute myeloid leukemia (AML), although the rates for the second case might be underestimated. The main reasons for CNS invasion are related to the expression of specific adhesion molecules (VLA-4, ICAM-1, VCAM, L-selectin, PECAM-1, CD18, LFA-1, CD58, CD44, CXCL12) by a subpopulation of leukemic cells, called "sticky cells" which have the ability to interact and adhere to endothelial cells. Moreover, the microenvironment becomes hypoxic and together with secretion of VEGF-A by ALL or AML cells the permeability of vasculature in the bone marrow increases, coupled with the disruption of blood brain barrier. There is a single subpopulation of leukemia cells, called leukemia stem cells (LSCs) that is able to resist in the new microenvironment due to its high adaptability. The LCSs enter into the arachnoid, migrate, and intensively proliferate in cerebrospinal fluid (CSF) and consequently infiltrate perivascular spaces and brain parenchyma. Moreover, the CNS is an immune privileged site that also protects leukemic cells from chemotherapy. CD56/NCAM is the most important surface molecule often overexpressed by leukemic stem cells that offers them the ability to infiltrate in the CNS. Although

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Section: Therapeutic Option For Cns Leukemiamentioning

confidence: 99%

A narrative review of central nervous system involvement in acute leukemias

Deak¹,

Gorcea-Andronic²,

Sas³

et al. 2021

Ann Transl Med

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“…In addition, it is often considered impractical in the setting of a poor overall prognosis. Although it is not standard practice, craniospinal irradiation may be used in the setting of LM from hematologic malignancies because these are frequently highly radiosensitive …”

Section: Treatmentmentioning

confidence: 99%

“…Although it is not standard practice, craniospinal irradiation may be used in the setting of LM from hematologic malignancies because these are frequently highly radiosensitive. 50,55,56…”

Section: Radiationmentioning

confidence: 99%

Leptomeningeal metastasis from systemic cancer: Review and update on management

Wang

Bertalan

Brastianos

2017

Cancer

209

234

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Leptomeningeal metastasis is an uncommon and typically late complication of cancer with a poor prognosis and limited treatment options. Diagnosis is often challenging, with nonspecific presenting symptoms ranging from headache and confusion to focal neurologic deficits, such as cranial nerve palsies. Standard diagnostic evaluation involves a neurologic examination, magnetic resonance imaging of the brain and spine with gadolinium, and cytologic evaluation of the cerebral spinal fluid. Therapy entails a multimodal approach focused on palliation with surgery, radiation, and/or chemotherapy, which may be administered systemically or directly into the cerebral spinal fluid. Limited trial data exist to guide treatment, and current regimens are based primarily on expert opinion. Although newer targeted and immunotherapeutic agents are under investigation and have shown promise, an improved understanding of the biology of leptomeningeal metastasis and treatment resistance as well as additional randomized controlled studies are needed to guide the optimal treatment of this devastating disease. Cancer 2018;124:21‐35. © 2017 American Cancer Society.

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“…Hyperfractionated RT with or without surgery [18] has also been reported to cause frequent grade 3 acute dermatitis. Proton beam therapy has emerged as a new approach to minimize excess dose and to decrease toxicity across many disease sites [22][23][24]. PBT decreases dose to the heart and lungs compared to conventional photon RT in breast cancer [25], as demonstrated by the minimal heart dose among our four patients.…”

mentioning

confidence: 77%

First report of proton beam therapy for breast angiosarcoma from the prospective PCG registry

et al. 2018

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View related articles View Crossmark data manifestation is thought to be related to dosing interval and the cumulative number of chemotherapy cycles [1,2]. Even though nail and skin toxicity are not life threatening, effective management to ameliorate the symptoms is a necessity to allow patients to continue their chemotherapy regimen. In some cases, patients may require dose adjustment, as was the case in a series of three patients with PATEO syndrome described by Rodriguez-Lomba et al. [3] Despite development of PATEO syndrome, our patient was able to continue her chemotherapy regimen with use of a potent topical corticosteroid and cooling her hands in ice baths during subsequent paclitaxel infusions, an approach similar to Scott e et al's [4,5] frozen glove therapy that was found to significantly reduce nail and skin toxicity associated with taxane-based chemotherapy. We present this case to heighten awareness of this unique manifestation of handfoot syndrome specific to taxane chemotherapy and share a successful approach towards management.

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Craniospinal irradiation prior to stem cell transplant for hematologic malignancies with CNS involvement: Effectiveness and toxicity after photon or proton treatment

Cited by 25 publications

References 39 publications

A narrative review of central nervous system involvement in acute leukemias

A narrative review of central nervous system involvement in acute leukemias

Leptomeningeal metastasis from systemic cancer: Review and update on management

First report of proton beam therapy for breast angiosarcoma from the prospective PCG registry

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