primary cns lymphoma: focus on role of radiation
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Dr. Rico LiuConsultant, Department of Clinical Oncology, Queen Mary Hospital
Honorary Clinical Associate Professor, Department of Clinical Oncology, The University of Hong Kong
Deputy Hospital Chief Executive, Queen Mary Hospital
BTG 2013 Feb 2013
Points for discussionEffects of radiation Radiotherapy is not for everyone but for
whom and when The role of new technology
Effects of radiation
External Radiotherapy•High energy Xray
• Photon- •Gama ray- from radioactive decay, e.g. Colbert
•High energy particles• Electron• Proton
BrachytherapySystemic radiotherapy
apoptosis
Effects of therapeutic radiation
Normal tissue tolerance
Milano et al., Semin Radiat Oncol. 17 (2007): 131-140
Treatment improves survival Median survival (mo)
Untreated ~2
WBRT alone ~12
Chemotherapy follows by WBRT
~ 48
Henry JM et al. Cancer 34: 1293, 1974 Nelson DF et al. IJROBP Volume 23, Issue 1, 1992, Pages 9–17Ferreri AJ et al. Ann Oncol. 2000 Aug;11(8):927-37
PCNSL: Radiotherapy alone RTOG 8315
Phase II study of WBRT 40Gy + 20Gy boostN = 41Overall median survival 12.2 monthsBenefit of boost doubtful: disease recurrence
frequently occurred in the boosted field, survival nobetter than previous study without use of boost
Ocular involvement: 36Gy to both eyes (or Rxwith high dose MTX)
Nelson DF et al. IJROBP Volume 23, Issue 1, 1992, Pages 9–17
PCNSL: Chemo + radiotherapy
CR 58%, PR 36% (Overall RR 94%) Overall survival 37 months 15% ( 12 patients) developed severe delayed neurologic toxicity
8 out of 12 died ( 5/8 from the group > 60 years of age and 3/8 from < 60 years of age)
Delayed neurotoxicity is worse for elderly patients
Omuro AM et al. Arch Neurol. 2005 Oct;62(10):1595-600
G-PCNSL-SG-1 trial
Not enough evidence to forgo WBRTLimitations of the trial
Low statistical power High protocol violationsHigh rate of lost to follow upSmall sample size in the analysis of
neurotoxicity
Lower dose of RT for patients with CR
WBRT- set up
Therapeutic management of PCNSL
Ferreri A J M Blood 2011;118:510-522Role of radiotherapy
The role of new technology
Neuro Oncol (August 2009) 11 (4): 423-429
SummaryPCNSL is rareChemotherapy +/- radiotherapy offer the best
survival Delayed neurotoxicity is common and can
cause major disability and death Reduce risk of delayed neurotoxicity
lower consolidation dose for patients <60defer WBRT for those older patients >60
Radiotherapy remains an effective treatment for patients considered not suitable for chemotherapy
Thank You
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