Early whole brain radiotherapy in primary CNS lymphoma: negative impact on quality of life in the randomized G-PCNSL-SG1 trial

Herrlinger, Ulrich; Schäfer, Niklas; Fimmers, Rolf; Griesinger, Frank; Rauch, Michael; Kirchen, Heinz; Roth, Patrick; Glas, Martin; Bamberg, M.; Martus, Peter; Thiel, Eckhard; Korfel, Agnieszka; Weller, Michael

doi:10.1007/s00432-017-2423-5

Cited by 61 publications

(32 citation statements)

References 24 publications

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“…PCNSL is extremely sensitive to radiation therapy, but its use in the initial treatment of PCNSL has waned overtime as chemotherapy-based induction regimens have been optimized. Phase III trial patients with newly diagnosed PCNSL were randomly assigned therapy to six cycles of chemotherapy alone (intravenous MTX+ Ifosfamide) or the same chemotherapy with WBRT (45 Gy in 1.5 Gy fractions) [23][24][25] (Figure 3). A total of 13% patients died during initial chemotherapy; 551 patients were enrolled and randomized, of whom 318 were treated per protocol of these, and 90 patients had a major protocol violation.…”

Section: Radiation Therapymentioning

confidence: 99%

“…Abbreviations: WBRT: whole brain radiotherapy; HD-MTX: high-dose methotrexate; CR: complete response; PR: partial response; SD: stable disease; PD: progressive disease; and HD-AraC: high-dose cytarabine. * Combined with ifosfamide 1.5 g/m 2 daily, d3-5, since 2006[23].…”

mentioning

confidence: 99%

“…Comparison of early-whole brain radiotherapy (WBRT) with no early-WBRT with regard to global health, cognitive-emotional-social functioning using the time course of median scores, interquartile ranges (IQR) for EORTC-QLQ-C30, BN20 dimensions, and the mini mental state examination (MMSE) of the G-PCNSL-SG-1 trial *p < 0.05. (A) scores for emotional and social functioning, (B) symptom scores and (C) Mini Mental State Examination (MMSE)[23].…”

mentioning

confidence: 99%

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The Role of Radiotherapy in the Treatment of Primary Central Nervous System Lymphomas

Kurt¹,

Abakay²,

Altay³

2020

Brain and Spinal Tumors - Primary and Secondary

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Primary central nervous system (PCNS) lymphomas are rare disease entities, though the incidence is increasing due to various immunosuppressive situations. The brain, eyes, and the spinal cord could be affected without any systemic disease involvement. Untreated PCNS lymphoma has been a rapidly fatal course. However, combined modality treatments have positive impact on overall survival. Pretreatment plan is formed by evaluating the treatment options to be used, disease involvement, and individual comorbidity. The PCNS lymphomas are known to be very sensitive to irradiation and chemotherapy treatments. The treatment plan is also generated according to the neurological condition and functional status of patients. The mainstay of induction therapy has been high dose methotrexate administration for most patients. The addition of radiotherapy as a consolidation treatment increases progression-free survival. The use of reduced irradiation dose and different fractionation schemes has been investigated in different studies to avoid the increased toxicity of high-dose whole-brain radiotherapy. High-dose chemotherapy, autologous hematopoietic cell transplantation, and whole-brain radiotherapy are alternative applications in patients with insufficient response to induction therapy. Stereotactic radiotherapy is another option in case of relapsed or refractory disease. Age and performance are also important indicators of survival and tumor progression.

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Section: Radiation Therapymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Role of Radiotherapy in the Treatment of Primary Central Nervous System Lymphomas

Kurt¹,

Abakay²,

Altay³

2020

Brain and Spinal Tumors - Primary and Secondary

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“…In patients receiving early WBRT after a high-dose methotrexate (HD-MTX) based chemotherapy regimen, global cognition as determined by MMSE in year 2 after randomization was worse compared with no early WBRT. 16 As the MMSE is insensitive for certain neurocognitive domains, the IPCG has developed an instrument for monitoring neurocognitive function. This assessment is composed of quality-of-life questionnaires and a focused neuropsychological test battery including assessment of executive function, attention, memory, and psychomotor speed.…”

Section: Follow-up and Neurotoxicitymentioning

confidence: 99%

Primary Central Nervous System Lymphoma

Low

Batchelor

2018

Semin Neurol

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Primary central nervous system lymphoma (PCNSL) is an extranodal non-Hodgkin lymphoma limited to the brain, spinal cord, leptomeninges, and eyes. The majority of patients are immunocompetent, with a median age of 65 years at diagnosis. Historically, whole-brain radiation therapy (WBRT) was the first and sole treatment for PCNSL. Today, due to the recognized neurotoxicity of WBRT, this modality is usually avoided in the treatment. Most chemotherapy regimens are based on high-dose methotrexate plus the anti-CD20 monoclonal antibody rituximab, leading to high response rates, but 5-year survival is still poor at approximately 30% compared with other extranodal lymphomas. New treatment strategies including high-dose chemotherapy/autologous stem cell transplantation, targeted therapies focusing on, for example, genetic alterations in B cells or mammalian target of rapamycin signaling, and immunotherapy with inhibitors of the programmed cell death 1 receptor are only a few options to improve the armamentarium against PCNSL.

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“…The use of whole-brain radiotherapy (WBRT) alone or in consolidation after high-dose methotrexate based on chemotherapy with systemic chemotherapy was the major risk factor for developing delayed neurotoxicity, especially for patients over 60 years old. [5] Concerning the patients that received early WBRT after a high-dose methotrexate (HD-MTX)-based on chemotherapy regimen, global cognition as determined by the Mini-Mental Status Examination (MMSE) in year 2 after randomization was worse compared with no early WBRT [6].…”

mentioning

confidence: 99%

Radiotherapy for Primary Central Nervous System Lymphoma

Bouanani¹,

Kouhen²

2020

IJAR

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Early whole brain radiotherapy in primary CNS lymphoma: negative impact on quality of life in the randomized G-PCNSL-SG1 trial

Abstract: The analysis of subjective QoL questionnaires and objective MMSE testing revealed that QoL and cognition were conserved in the arm without early WBRT. Thus, even though it was an exploratory analysis, the results of G-PCNSL-SG1 challenge the place of WBRT in the primary therapy of PCNSL.

Cited by 61 publications

References 24 publications

The Role of Radiotherapy in the Treatment of Primary Central Nervous System Lymphomas

The Role of Radiotherapy in the Treatment of Primary Central Nervous System Lymphomas

Primary Central Nervous System Lymphoma

Radiotherapy for Primary Central Nervous System Lymphoma

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