Efficacy and toxicity with radiation field designs and concurrent temozolomide for CNS lymphoma

Authors

Anna M. Laucis, Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
Katherine Selwa, Department of Neurology, University of Michigan Hospital, Ann Arbor, MI, USA.
Yilun Sun, Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
Michelle M. Kim, Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
Kyle C. Cuneo, Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
Theodore S. Lawrence, Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
Daniel R. Wahl, Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
Larry Junck, Department of Neurology, University of Michigan Hospital, Ann Arbor, MI, USA.
Yoshie Umemura, Department of Neurology, University of Michigan Hospital, Ann Arbor, MI, USA.

Document Type

Article

Abstract

BACKGROUND: There is no consensus on the treatment of central nervous system (CNS) lymphoma refractory to first-line methotrexate-based chemotherapy. Whole brain radiotherapy (WBRT) is sometimes used but may result in unacceptable neurocognitive dysfunction. We examined the efficacy and toxicities of WBRT with or without concurrent temozolomide in CNS lymphoma treatment. METHODS: This single-institution IRB-approved retrospective study included adults with CNS lymphoma who received WBRT, either consolidative low-dose WBRT alone or low-dose WBRT with a focal boost to residual disease and were previously treated with high-dose methotrexate. The relationships between the WBRT regimen, concurrent temozolomide, and clinical outcomes and toxicities were assessed using proportional hazards and logistic regression models. RESULTS: A total of 45 patients with a median age of 64 years (range 24-74) treated from 2004 to 2019 were included. In total, 20 patients received concurrent temozolomide. In the WBRT + Boost cohort ( = 32), concurrent temozolomide resulted in better 2-year overall survival (OS) and progression free survival (PFS) (73% OS and 66% PFS) compared to patients treated without concurrent temozolomide (44% OS and 24% PFS). On multivariate analysis, concurrent temozolomide was associated with significantly better PFS (HR 0.28, = .02). There were no significant differences between the two radiation groups or between those treated with or without concurrent temozolomide, with respect to significant acute hematologic, non-hematologic, and long-term neurocognitive toxicities ( > .05). CONCLUSIONS: In this study, concurrent temozolomide with radiotherapy in CNS lymphoma was associated with better PFS and was well tolerated. Low-dose WBRT with a boost is a safe and reasonable treatment approach for focal refractory disease. Prospective research that includes rigorous neurocognitive assessments is now warranted.

Publication Date

12-1-2022

Publication Title

Neuro-oncology practice

ISSN

2054-2577

Volume

9

Issue

6

First Page

536

Last Page

544

PubMed ID

36388411

Digital Object Identifier (DOI)

10.1093/nop/npac052

Recommended Citation

Laucis, Anna M.; Selwa, Katherine; Sun, Yilun; Kim, Michelle M.; Cuneo, Kyle C.; Lawrence, Theodore S.; Wahl, Daniel R.; Junck, Larry; and Umemura, Yoshie, "Efficacy and toxicity with radiation field designs and concurrent temozolomide for CNS lymphoma" (2022). Neurology. 1449.
https://scholar.barrowneuro.org/neurology/1449