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Is reduced-dose whole-brain radiotherapy also feasible in primary CNS lymphoma for curative or salvage purpose?

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Abstract

Purpose

Recently, reduced-dose whole-brain radiotherapy (WBRT) has been used to treat primary central nervous system lymphoma (PCNSL). However, whether reduced-dose WBRT is also an acceptable option for curative or salvage purposes has not yet been reported. We analyzed the clinical outcomes of patients with PCNSL who received radiotherapy for curative or salvage purposes and compared the clinical outcomes according to the WBRT dose.

Methods

A total of 66 patients were divided into two groups: those treated with 30 Gy (2 Gy per fraction) or less WBRT (low-dose WBRT, n = 34) and those treated with more than 30 Gy WBRT (high-dose WBRT, n = 32). The median WBRT dose was 25.2 and 49.6 Gy in low-dose and high-dose WBRT groups, respectively. The median total radiotherapy dose, including the boost dose, was 50 Gy (range, 36.0-55.8 Gy).

Results

The 3-year overall survival and progression-free survival were 77.8% and 29.8%, respectively. Intracranial relapse occurred in 31 patients (47.0%) at a median of 27 months after RT. Overall survival and progression-free survival did not differ between the two groups. The 3-year intracranial disease control rate did not differ between the two groups (35.2% vs. 41.6%, p = 0.300). Grade 3 or higher neurological toxicities were observed in six patients, of whom five were in the high-dose WBRT group.

Conclusion

Reduced-dose WBRT in curative and salvage treatments for PCNSL had no significant negative effect on the intracranial disease control rate or survival. Therefore, without impaired efficacy, use of reduced-dose WBRT appears promising for reduction of neurotoxicity.

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Author notes

  1. Min-Kyun Ko and Yoo-Kang Kwak contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Min-Kyun Ko, Byung-Ock Choi & Jin-Ho Song

  2. Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsuro, Bupyung-gu, Incheon, 21431, Republic of Korea

    Yoo-Kang Kwak

  3. Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    Sin-Soo Jeun, Jae-Sung Park & Stephen Ahn

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection were performed by MK Ko, BO Choi, SS Jeun, S Ahn and analysis were performed by MK Ko, JH Song, JS Park. The first draft of the manuscript was written by YK Kwak, JH Song and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jin-Ho Song.

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This study was approved by institution’s review board (IRB).

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The retrospective design exempted this study from the requirement to obtain written informed consent from the patients.

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The authors declare no competing interests.

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Ko, MK., Kwak, YK., Choi, BO. et al. Is reduced-dose whole-brain radiotherapy also feasible in primary CNS lymphoma for curative or salvage purpose?. J Neurooncol 165, 321–328 (2023). https://doi.org/10.1007/s11060-023-04504-2

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  • DOI: https://doi.org/10.1007/s11060-023-04504-2

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