Is deep brain involvement in intracranial primary central nervous system lymphoma of importance for penetration of chemotherapeutic agents?

Meling, Torstein R.; Latysheva, Anna; Broi, Michele Da; Jahr, Guro; Holte, Harald; Beiske, Klaus; Emblem, Kyrre E.

doi:10.1007/s00234-018-2038-9

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…Interestingly, patients over 60 were more likely to be prescribed a boost compared to younger patients ≤60 (81.8% versus 50%, respectively), and patients over 60 made up the majority of the patients receiving a boost (64.3%) compared with just 40% of the patients not receiving a boost. Increasing age is a negative prognostic factor, and it is interesting to note that in our cohort, survival and response outcomes were slightly better among patients who received a boost, despite there being a higher proportion of older patients in this group [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The rates of boost implementation was not found to differ based on lesion number, with 50% of patients with solitary lesions and 50% of patients with multiple lesions prescribed a boost. Prior studies have failed to demonstrate that the number of brain lesions in patients with PCNSL is an independent prognostic factor for survival or response [ 20 , 21 , 22 ]. That being said, we recognize that for our specific cohort of patients, we can not definitively state that our outcomes were not affected by the higher proportion of patients with multiple lesions represented in the WBRT >30 Gy treatment group.…”

Section: Discussionmentioning

confidence: 99%

“…Larger maximum tumour size was associated with increased rates of boost utilization, however, with 88.9% of patients with tumor size >3 cm receiving a boost, compared to 50% of patients with tumour size ≤3 cm. There is conflicting evidence in the literature regarding size of the primary tumour as a prognostic factor [ 21 , 23 , 24 ]. While no consensus exists regarding the nature of tumour size as a prognostic factor in PCNSL, we can not be certain that it did not influence outcomes in our particular study, given that the proportion of patients with tumours >3 cm made up 57.1% of those receiving a boost and 14.2% of those receiving no boost.…”

Section: Discussionmentioning

confidence: 99%

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Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma

et al. 2022

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Primary central nervous system lymphoma (PCNSL) is a rare malignancy. Standard of care is upfront high-dose methotrexate (HD-MTX) chemotherapy, while cranial radiation is more commonly used in the salvage setting. In this retrospective study, we aimed to investigate the safety and efficacy of salvage cranial radiation in PCNSL. PCNSL patients who received upfront HD-MTX chemotherapy and salvage cranial radiation after treatment failure between 1995 and 2018 were selected. Radiological response to cranial radiation was assessed as per Response Assessment in Neuro-Oncology Criteria. Twenty one patients were selected (median age 59.9 years), with median follow-up of 19.9 months. Fourteen patients (66.7%) received a boost to the gross tumour volume (GTV). Four patients (19.0%) sustained grade ≥2 treatment-related neurotoxicity post-completion of cranial radiation. Of the 19 patients who had requisite MRI with gadolinium imaging available for Response Assessment in Neuro-Oncology (RANO) criteria assessment, 47.4% achieved complete response, 47.4% achieved partial response, and 5.3% of patients exhibited stable disease. Higher dose to the whole brain (>30 Gy) was associated with higher rate of complete response (63.6%) than lower dose (≤30 Gy, 37.5%), while boost dose to the gross disease was also associated with higher rate of complete response (61.5%) compared with no boost dose (33.3%). Median overall survival was 20.0 months. PCNSL patients who relapsed following upfront chemotherapy showed a high rate of response to salvage cranial radiation, especially in those receiving greater than 30 Gy to the whole brain and boost to gross disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma

et al. 2022

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“…Conflicting evidence also exists for the possible negative prognostic value of the anatomic tumour size at baseline [29,34]. Number of enhancing lesions, cortical invasion and contrast enhancement pattern have not been linked to poorer outcomes [5 ▪ ,32,33].…”

Section: Neuroradiological Featuresmentioning

confidence: 99%

Prognostic factors in primary central nervous system lymphoma

Morales-Martínez¹,

Nichelli

Hernández-Verdin

et al. 2022

Current Opinion in Oncology

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Purpose of reviewPrimary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal diffuse large B cell lymphoma. Despite its apparent immunopathological homogeneity, PCNSL displays a wide variability in outcome. Identifying prognostic factors is of importance for patient stratification and clinical decision-making. The purpose of this review is to focus on the clinical, neuroradiological and biological variables correlated with the prognosis at the time of diagnosis in immunocompetent patients.Recent findingsAge and performance status remain the most consistent clinical prognostic factors. The current literature suggests that neurocognitive dysfunction is an independent predictor of poor outcome. Cumulating data support the prognostic value of increased interleukin-10 level in the cerebrospinal fluid (CSF), in addition to its interest as a diagnostic biomarker. Advances in neuroimaging and in omics have identified several semi-quantitative radiological features (apparent diffusion restriction measures, dynamic contrast-enhanced perfusion MRI (pMRI) pattern and 18F-fluorodeoxyglucose metabolism) and molecular genetic alterations with prognostic impact in PCNSL.SummaryValidation of new biologic and neuroimaging markers in prospective studies is required before integrating future prognostic scoring systems. In the era of radiomic, large clinicoradiological and molecular databases are needed to develop multimodal artificial intelligence algorithms for the prediction of accurate outcome.

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“…The risk factors for poor outcomes include impaired immune status, increased patient age, poor clinical performance, and the non-receipt or failure of first-line chemotherapy [ 20 , 21 , 22 , 23 , 24 , 25 ]. In addition, a negative prognostic role has been postulated for the involvement of deep brain structures [ 24 , 25 , 26 ]. In contrast, analyses of tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) have yielded controversial or inconclusive results [ 27 , 28 , 29 , 30 , 31 , 32 ] and were found to differ between CNS and non-CNS lymphoma [ 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Differences in Primary CNS Lymphoma

Roetzer

Furtner

Gesperger

et al. 2020

Cancers

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Sex-specific differences have been increasingly recognized in many human diseases including brain cancer, namely glioblastoma. Primary CNS lymphoma (PCNSL) is an exceedingly rare type of brain cancer that tends to have a higher incidence and worse outcomes in male patients. Yet, relatively little is known about the reasons that contribute to these observed sex-specific differences. Using a population-representative cohort of patients with PCNSL with dense magnetic resonance (MR) imaging and digital pathology annotation (n = 74), we performed sex-specific cluster and survival analyses to explore possible associations. We found three prognostically relevant clusters for females and two for males, characterized by differences in (i) patient demographics, (ii) tumor-associated immune response, and (iii) MR imaging phenotypes. Upon a multivariable analysis, an enhanced FoxP3+ lymphocyte-driven immune response was associated with a shorter overall survival particularly in female patients (HR 1.65, p = 0.035), while an increased extent of contrast enhancement emerged as an adverse predictor of outcomes in male patients (HR 1.05, p < 0.01). In conclusion, we found divergent prognostic constellations between female and male patients with PCNSL that suggest differential roles of tumor-associated immune response and MR imaging phenotypes. Our results further underline the importance of continued sex-specific analyses in the field of brain cancer.

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Is deep brain involvement in intracranial primary central nervous system lymphoma of importance for penetration of chemotherapeutic agents?

Cited by 6 publications

References 40 publications

Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma

Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma

Prognostic factors in primary central nervous system lymphoma

Sex-Specific Differences in Primary CNS Lymphoma

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