Radiation as an Effective Salvage Therapy for Secondary CNS Lymphoma
Menée auprès d'une cohorte de 44 patients atteints d'un lymphome systémique diffus à grandes cellules B avec atteinte secondaire du cerveau et/ou des leptoméninges, cette étude évalue l'efficacité, du point de vue de la réponse thérapeutique mesurée par IRM, de la progression de la maladie et de la survie globale, d'une radiothérapie de sauvetage ciblant le système nerveux central
We assessed the efficacy of radiation therapy (RT) in the management of secondary central nervous system (CNS) lymphoma. The cohort comprised 44 patients with systemic diffuse large-B cell lymphoma (DLBCL) secondarily involving the brain and/or leptomeninges at initial diagnosis or relapse, who received RT. Twenty-nine patients (66%) were in systemic remission when diagnosed with CNS disease. The overall response rate to RT by magnetic resonance imaging was 88% (42% complete, 46% partial). The median overall survival (OS) after RT initiation was 7 months (95% CI: 4-10 months). The OS curve plateaued at 31% from 2 to 8 years. OS was superior in patients who achieved a complete or partial response to RT, underwent stem cell transplantation (SCT) after RT, and had brain parenchymal (vs. leptomeningeal) disease. Eight cases of CNS disease progression occurred after RT: one involved the brain parenchyma and 7 involved the spine and/or CSF/meninges. We conclude that RT is associated with high response rates and may contribute to long-term OS. Additionally, RT may provide CNS disease control that facilitates successful salvage with SCT in patients with chemorefractory disease.