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

Supportive Care in Cancer volume 28, pages 5363–5369 (2020)Cite this article

Abstract

Purpose

Primary central nervous system lymphoma (PCNSL) is a very rare type of malignancy with a poor prognosis. The role of whole brain radiotherapy (WBRT) in PCNSL has been questioned due to the significant neurotoxicity and lack of convincing data for survival benefit. Even its role in a palliative setting remains to be clearly elucidated. Our study aims to investigate the benefit of WBRT in patients who are ineligible for systemic therapy.

Methods

A single-institution retrospective study was conducted on patients diagnosed with PCNSL between 2002 and 2017. Patients were excluded if they received systemic therapy or focal radiation only. Data on patient demographics and WBRT were collected and correlated with clinical outcomes.

Results

A total of 48 patients were selected for analysis, among which 31 (64.6%) patients received WBRT and 17 (35.4%) patients received supportive care only. Patient baseline characteristics were similar between the two groups. Median overall survival (OS) was 4.3 months among the entire cohort. WBRT was associated with improved median OS (8.0 months, range 1.4–62.3 months) compared with supportive care only (3.3 months, range 0.7–18.3 months) (HR 0.39, 95% CI 0.20–0.75, p = 0.005). Among patients who received WBRT, higher radiation dose to the whole brain was not associated with survival (p = 0.10), but higher radiation dose to the gross tumor was associated with improved survival (p = 0.007).

Conclusion

Patients with PCNSL who are ineligible for systemic therapy may still benefit from WBRT with improvement in survival, compared with the best supportive care. Dose escalation through the addition of a gross tumor boost in these patients was associated with improved overall survival. Further studies in the prospective setting are necessary to confirm the findings from the study.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Affiliations

  1. Division of Radiation Oncology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Jiheon Song, Rajiv Samant & Vimoj Nair

  2. Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada

    Mohammad Jay

  3. Ottawa Hospital Research Institute, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

    Hina Chaudry

  4. Division of Family Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Xin Yan Fan

  5. Division of Hematology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    David MacDonald & Isabelle Bence-Bruckler

Authors
  1. Jiheon Song
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  2. Rajiv Samant
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  3. Mohammad Jay
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  4. Hina Chaudry
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  5. Xin Yan Fan
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  6. David MacDonald
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  7. Isabelle Bence-Bruckler
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  8. Vimoj Nair
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jiheon Song, Mohammad Jay, Hina Chaudry, and Xin Yan Fan. The first draft of the manuscript was written by Jiheon Song, and study conceptualization and design were performed by Rajiv Samant, David MacDonald, Isabelle Bence-Bruckler, and Vimoj Nair. Manuscript review and editing were performed by Rajiv Samant and Vimoj Nair. Supervision of the study was conducted by Vimoj Nair.

Corresponding author

Correspondence to Jiheon Song.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not required as part of the study, as the study was retrospective in nature. Information on individual patients on which this study was conducted has been anonymized where appropriate and no identifying details of the individual patients are described in this manuscript.

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Song, J., Samant, R., Jay, M. et al. Whole brain radiotherapy improves survival outcomes in primary CNS lymphoma patients ineligible for systemic therapy. Support Care Cancer 28, 5363–5369 (2020). https://doi.org/10.1007/s00520-020-05376-2

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  • DOI: https://doi.org/10.1007/s00520-020-05376-2

Keywords

  • Palliative radiotherapy
  • Primary central nervous system lymphoma
  • Radiation oncology
  • Whole brain radiotherapy