Copenhagen, Denmark
Onsite/Online

ESTRO 2022

Session Item

Monday
May 09
16:45 - 17:45
Room D1
CNS
Danielle Eekers, The Netherlands;
Maarten Lambrecht, Belgium
3460
Proffered Papers
Clinical
17:35 - 17:45
How to manage consolidative radiotherapy after HD methotrexate in PCNSL patients: a phase II study
Silvia Chiesa, Italy
OC-0929

Abstract

How to manage consolidative radiotherapy after HD methotrexate in PCNSL patients: a phase II study
Authors:

Silvia Chiesa1, Francesco Beghella Bartoli1, Ciro Mazzarella1, Stefan Hohaus2, Maria Chiara Cannatà1, Francesco Catucci3, Francesco D'Alò4, Serena Bracci5, Alessia Nardangeli5, Antonella Martino6, Nicola Dinapoli5, Fabio Marazzi5, Stefania Manfrida5, Maria Antonietta Gambacorta5,7, Cynthia Aristei8, Vincenzo Valentini1,7, Mario Balducci1,7

1Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; 2Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, , Rome, Italy; 3Mater Olbia Hospital, Radiation Oncology, Olbia, Italy; 4Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC di Ematologia, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; 5 Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; 6 Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy; 7Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy; 8Università degli studi di Perugia, Azienda Ospedaliera di Perugia, Sezione di Radioterapia Oncologica, Dipartimento di Chirurgia e Scienze Biomedicali, Perugia, Italy

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Purpose or Objective

The purpose of this study is to evaluate the addition of temozolomide (TMZ) to consolidation radiotherapy in a subset of patients with primary cerebral lymphoma (PCNSL) previously treated with high-dose methotrexate (MTX-HD) in terms of overall survival (OS).

Material and Methods

This study considered patients with histologically proven diagnosis of PCNSL treated in induction therapy with HD-MTX based chemotherapy who were not candidates for autologous stem-cell transplantation or other consolidation chemotherapy who were subsequently subjected to radiation therapy plus Temozolomide. Two clinical Target Volumes (CTVs) were defined: CTV2 was represented by Whole Brain plus leptomeninges until C2, reaching a dosage of 30 Gy in 15 daily fractions, while CTV1 comprising the initial disease location and residual mass if present. The total dose delivered on CTV1 was related to the type of response had to treatment with HD-MTX (complete response = 6 Gy, partial response = 10 Gy, progression disease = 16 Gy). Temozolomide was administered concomitantly at the dose of 75 mg/mq/die according to our previous phase I escalation study1


Results

Thirty-eight patients were enrolled from March 2004 to December 2019: 21 male and 17  female. Median age was 66 yrs (range 23-82). Twenty-five out of 38 patients received two cycle of MTX-HD, 9 patients received only one cycle of HD-MTX because of hematological toxicity and 4 patients did not received any cycle due to poor performance status. Ten patients underwent macroscopic surgical excision, while 28 patients received biopsy. In 28 patients TMZ was associated to radiotherapy. At a median follow up of 113 months (range 21-207), 4 of 38 patients (10,5%) are alive and without disease, 32 patients died because of disease and two patients died because of other causes.  Median OS for all patients was 18.3 months with at 1 yrs OS of 60% and at 3 yrs OS of 36% of patients (Fig.1).  The use of concomitant TMZ significantly impact the OS (p=0.002) (Fig.2).


Conclusion

This analysis shows that the addition of TMZ at the dose of 75 mg/mq, in a selected patients population, could be a reasonable option as consolidation therapy after HD-MTX , due to the  better outcome compared to RT alone and to the clinical outcomes of the entire study population aligned with literature data2.


1.       Chiesa S, Hohaus S, Falcinelli L et al. Chemoradiotherapy with temozolomide after high-dose methotrexate for primary CNS lymphoma: a multicenter phase I study of a response-adapted strategy. Ann Hematol. 2020 Oct;99(10):2367-2375. doi: 10.1007/s00277-020-04220-1.


2.       Houillier C, et al Management and outcome of primary CNS lymphoma in the modern era: An LOC network study. Neurology. 2020 Mar10;94(10):e1027-e1039. doi: 10.1212/WNL.0000000000008900. Epub 2020 Jan 6. PMID: 31907289; PMCID: PMC7238921.