Whole brain radiotherapy improves survival outcomes in primary CNS lymphoma patients ineligible for systemic therapy

Song, Jiheon; Samant, Rajiv; Jay, Mohammad; Chaudry, Hina; Fan, Xin Yan; Macdonald, D. Blair; Bence‐Bruckler, Isabelle; Nair, Vimoj

doi:10.1007/s00520-020-05376-2

Cited by 10 publications

(10 citation statements)

References 19 publications

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“… 20 , 21 With concerns over the long-term neurotoxicity of radiation, 22 oncologists have moved away from WBRT as consolidation in first-line therapy. 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

“…20,21 With concerns over the long-term neurotoxicity of radiation, 22 oncologists have moved away from WBRT as consolidation in first-line therapy. 23,24 Given the rarity of PCNSL and the paucity of Phase III randomized clinical trials for potential treatments, no consensus exists on the optimal frontline regimens, chemotherapeutic agents in addition to HD-MTX, or consolidation therapy with WBRT versus high-dose chemotherapy and autologous stem cell transplant (ASCT). HD-MTX has been proven to reach a therapeutic concentration in the brain and is now considered the first-line treatment of PCNSL, 13 and doses of MTX in the range of 3-8 g/m 2 are frequently used.…”

Section: Discussionmentioning

confidence: 99%

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Improvement of outcomes of an escalated high‐dose methotrexate-based regimen for patients with newly diagnosed primary central nervous system lymphoma: a real-world cohort study

Li¹,

Ma²,

Ma³

et al. 2021

CMAR

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Purpose High‐dose methotrexate (HD‐MTX)-based chemotherapy regimen is the first-line treatment of primary central nervous system lymphoma (PCNSL). At present, doses of MTX in the range of 3.5–8 g/m 2 are frequently used. However, the optimal dose of methotrexate for PCNSL remains controversial. The purpose of this real-world study was to compare the efficacy and toxicity of HD-MTX in patients with untreated PCNSL. Methods Immunocompetent adults with newly diagnosed PCNSL between January 2015 and December 2018 were investigated and followed up to June 2019. All patients’ initial treatments were based on HD‐MTX chemotherapy regimens. Results A total of 73 patients were reviewed. For patients who received HD-MTX at 8 g/m 2 vs.3.5 g/m 2 , the complete response (CR) rates were 68.29% vs 43.75% (p = 0.03), and the median PFS times were 17.7 months vs 9.05 months (HR=0.455, 95% CI 0.239–0.865, p=0.016). There was no significant difference in OS between the two groups. Serious adverse effects were uncommon and clinically manageable. Conclusion There is a correlation of treatment response and clinical outcomes between the dosage of MTX in initial induction therapy in newly diagnosed PCNSL. MTX dose of 8 g/m 2 provided a higher CR rate and PFS benefits with acceptable adverse effects.

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“… 20 , 21 With concerns over the long-term neurotoxicity of radiation, 22 oncologists have moved away from WBRT as consolidation in first-line therapy. 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improvement of outcomes of an escalated high‐dose methotrexate-based regimen for patients with newly diagnosed primary central nervous system lymphoma: a real-world cohort study

Li¹,

Ma²,

Ma³

et al. 2021

CMAR

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“…96 Other multicentre retrospective studies of elderly PCNSL treated with upfront WBRT have shown OS ranging from seven to eight months. 95,97,98 Risk and benefit ratio should be carefully considered when offering WBRT in this clinical context.…”

Section: Role Of Palliative and Best Supportive Carementioning

confidence: 99%

Advances in treatment of elderly primary central nervous system lymphoma

et al. 2021

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The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comorbidities influence individualised treatment approaches and geriatric assessment tools are increasingly utilised. Optimal induction treatment remains high-dose methotrexatebased immunochemotherapy, delivery is feasible in the majority of patients and the goal of treatment remains achieving complete remission. Consolidation strategies are also relevant in the elderly, aiming to maximise duration of response and quality of life (QoL). Potential options include high-dose therapy with haematopoietic stem cell consolidation, non-myeloablative chemotherapy and whole-brain radiotherapy. Efficacy of novel agents, such as Bruton tyrosine kinase inhibitors and lenalidomide, have been reported; these represent an alternative for elderly patients unfit for chemotherapy. Prognosis remains poor, improvement of outcomes in this age group is urgently needed.

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“…It has recently been reported that deep-learning techniques provide improved workflow for radiation therapy. [14][15][16][17] The outcomes of the contouring tasks performed by deep-learning methods are improved consistency of contouring quality and reduced contouring time. [14][15][16] Also, the automated RTP with deep learning provides shorter planning time with lower error rate.…”

mentioning

confidence: 99%

“…[14][15][16][17] The outcomes of the contouring tasks performed by deep-learning methods are improved consistency of contouring quality and reduced contouring time. [14][15][16] Also, the automated RTP with deep learning provides shorter planning time with lower error rate. 17 In this study, we investigate the feasibility of an automated RTP for WBRT, designed using deep-learning techniques for predicting the multileaf collimator (MLC) shape bypassing the contouring processes.…”

mentioning

confidence: 99%

Feasibility of automated planning for whole‐brain radiation therapy using deep learning

Goh

Song

et al. 2020

J Applied Clin Med Phys

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Purpose: The purpose of this study was to develop automated planning for wholebrain radiation therapy (WBRT) using a U-net-based deep-learning model for predicting the multileaf collimator (MLC) shape bypassing the contouring processes. Methods: A dataset of 55 cases, including 40 training sets, five validation sets, and 10 test sets, was used to predict the static MLC shape. The digitally reconstructed radiograph (DRR) reconstructed from planning CT images as an input layer and the MLC shape as an output layer are connected one-to-one via the U-net modeling. The Dice similarity coefficient (DSC) was used as the loss function in the training and ninefold cross-validation. Dose-volume-histogram (DVH) curves were constructed for assessing the automatic MLC shaping performance. Deep-learning (DL) and manually optimized (MO) approaches were compared based on the DVH curves and dose distributions.Results: The ninefold cross-validation ensemble test results were consistent with DSC values of 94.6 ± 0.4 and 94.7 ± 0.9 in training and validation learnings, respectively. The dose coverages of 95% target volume were (98.0 ± 0.7)% and (98.3 ± 0.8)%, and the maximum doses for the lens as critical organ-at-risk were 2.9 Gy and 3.9 Gy for DL and MO, respectively. The DL technique shows the consistent results in terms of the DVH parameter except for MLC shaping prediction for dose saving of small organs such as lens.Conclusions: Comparable with the MO plan result, the WBRT plan quality obtained using the DL approach is clinically acceptable. Moreover, the DL approach enables WBRT auto-planning without the time-consuming manual MLC shaping and target contouring.whole-brain radiation therapy, deep learning, automatic planning | INTRODUCTIONMetastatic brain cancer is the most common type of intracranial tumor. 1 From common primary cancer sites such as lung, breast, and melanoma, brain metastasis occurs in 15% to 40% of the cancer patients. 2,3 The treatment of metastatic brain tumors depends on the number of metastatic tumors, extracranial tumor status, and performance status. [4][5][6] Currently, whole-brain radiation therapy (WBRT) is considered a well-established treatment for patients with multiple brain metastases.

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Whole brain radiotherapy improves survival outcomes in primary CNS lymphoma patients ineligible for systemic therapy

Cited by 10 publications

References 19 publications

Improvement of outcomes of an escalated high‐dose methotrexate-based regimen for patients with newly diagnosed primary central nervous system lymphoma: a real-world cohort study

Improvement of outcomes of an escalated high‐dose methotrexate-based regimen for patients with newly diagnosed primary central nervous system lymphoma: a real-world cohort study

Advances in treatment of elderly primary central nervous system lymphoma

Feasibility of automated planning for whole‐brain radiation therapy using deep learning

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