Salvage radiotherapy in patients with recurrent or refractory primary or secondary central nervous system lymphoma after methotrexate-based chemotherapy

Khimani, Namrata; Ng, Andrea K.; Chen, Yu Hui; Catalano, Paul J.; Silver, Barbara; Mauch, Peter

doi:10.1093/annonc/mdq548

Cited by 26 publications

(17 citation statements)

References 15 publications

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“…In patients with primary or secondary CNS lymphoma who either develop a relapse after, or who are refractory to, CNS-directed chemotherapy, salvage RT can provide effective palliation and in some cases long-term disease control (35)(36)(37). In patients with relapsed or refractory CNS lymphoma and good performance status, HDT-ASCT has been used as salvage, although these programs have not typically included the use of RT (38)(39)(40)(41).…”

Section: Scenario 6: Relapsed/refractory Primary or Secondary Cns Lymmentioning

confidence: 99%

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Role of Radiation Therapy in Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

Yahalom

Goda

et al. 2018

International Journal of Radiation Oncology*Biology*Physics

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Approximately 30% to 40% of patients with diffuse large B-cell lymphoma (DLBCL) will have either primary refractory disease or relapse after chemotherapy. In transplant-eligible patients, those with disease sensitive to salvage chemotherapy will significantly benefit from high-dose therapy with autologous stem cell transplantation. The rationale for considering radiation therapy (RT) for selected patients with relapsed/refractory DLBCL as a part of the salvage program is based on data regarding the patterns of relapse and retrospective series showing improved local control and clinical outcomes for patients who received peritransplant RT. In transplant-ineligible patients, RT can provide effective palliation and, in selected cases, be administered with curative intent if the relapsed/refractory disease is localized. We have reviewed the indications for RT in the setting of relapsed/refractory DLBCL and provided recommendations regarding the optimal timing of RT, dose fractionation scheme, and treatment volume in the context of specific case scenarios.

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Section: Scenario 6: Relapsed/refractory Primary or Secondary Cns Lymmentioning

confidence: 99%

“…Several studies have explored the role of salvage whole brain RT for patients with primary or secondary CNS lymphoma who either developed a relapse after or had refractory disease to CNS-directed chemotherapy (35)(36)(37). The median RT dose in these studies ranged from 36 to 40 Gy.…”

Section: Scenario 6: Relapsed/refractory Primary or Secondary Cns Lymmentioning

confidence: 99%

Role of Radiation Therapy in Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

Yahalom

Goda

et al. 2018

International Journal of Radiation Oncology*Biology*Physics

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“…Median survival was 10.9 months and median PFS was 9.7 months. Khimani et al have reported an overall survival of 11.7 months with a CR of 50% with salvage WBRT in patients with primary or secondary CNSL 83. The median survival after salvage WBRT is comparable to the treatment with WBRT given as a first line treatment.…”

Section: Salvage Therapymentioning

confidence: 96%

Current and Emerging Pharmacotherapies for Primary CNS Lymphoma

Prodduturi

Bierman

2012

Clin Med Insights Oncol

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Primary central nervous system lymphoma (PCNSL) constitutes a rare group of extranodal non-Hodgkin’s lymphoma (NHL) primarily of B cell origin. It occurs in both immuno-competent and immune-compromised patients. High dose m ethotrexate (HD-MTX) based chemotherapy is the standard therapy. Chemotherapy with whole brain radiation therapy (WBRT) improves response rates and survival compared with WBRT alone. However, due to the increased risk for neurotoxicity with WBRT, recent studies have focused on using chemotherapy alone. Methotrexate based multi-agent chemotherapy without WBRT is associated with similar t reatment rates and survival compared with regimens that include WBRT although controlled trials have not been performed. Because of the low incidence of this disease, it is difficult to conduct randomized controlled trials. In this article we have discussed about the past, present and emerging treatment options in patients with PCNSL.

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“…Either HDT‐ASCT or WBRT should be considered in second remission if not undertaken as first‐line consolidation therapy. WBRT alone (median dose 36–40 Gy) can result in CR rates of 37–58% and a median survival of 10–16 months in radiotherapy‐naïve patients who are refractory to, or relapse after, HD‐MTX therapy (Nguyen et al , ; Hottinger et al , ; Khimani et al , ).…”

Section: Relapsed and Refractory Pcnslmentioning

confidence: 99%

Guidelines for the diagnosis and management of primary central nervous system diffuse large B‐cell lymphoma

et al. 2018

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Salvage radiotherapy in patients with recurrent or refractory primary or secondary central nervous system lymphoma after methotrexate-based chemotherapy

Abstract: Salvage RT is effective for patients with recurrent/refractory primary or secondary CNSL after initial MTX therapy. Having received five or more cycles of MTX before failure and CNSL limited to the brain at relapse are associated with longer OS.

Cited by 26 publications

References 15 publications

Role of Radiation Therapy in Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

Role of Radiation Therapy in Patients With Relapsed/Refractory Diffuse Large B-Cell Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

Current and Emerging Pharmacotherapies for Primary CNS Lymphoma

Guidelines for the diagnosis and management of primary central nervous system diffuse large B‐cell lymphoma

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