CSI or whole brain irradiation combined with HSCT for CNS recurrence of hematopoietic tumors.
PO-1132
Abstract
CSI or whole brain irradiation combined with HSCT for CNS recurrence of hematopoietic tumors.
Authors: Yuri Shimizu1, Satoshi Nakamura2, Hiroyuki Okamoto2, Tetsu Nakaichi2, Ako Aikawa3, Jun Itami4, HIroshi Igaki3
1Shin-Matsudo central general hospital, Radiation Therapy , Chiba, Japan; 2National Cancer Center Hospital, Medical Physics, Tokyo, Japan; 3National Cancer Center Hospital, Radiation Oncology, Tokyo, Japan; 4Shin-Matsudo central general hospital, Radiation Therapy, Chiba, Japan
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Purpose or Objective
In order to determine the index for selecting appropriate radiation coverage, we reviewed the progress of patients who underwent hematopoietic stem cell transplantation (HSCT) and craniospinal irradiation (CSI) or whole brain irradiation (WBI) for central nervous system (CNS) recurrence of hematopoietic tumors.
Material and Methods
Time to relapse and overall survival were verified for 27 patients who underwent HSCT and WBI or CSI therapy for CNS recurrent of hematopoietic tumors, at a single institution between January 2007 and March 2022,
Results
Median age 50 years (17-66), median observation period 7 months (0.9-139 months).
Patients included 5 AML, 8 ALL/LBL, 5 DLBCL, 8 ATL, 1 ENKL.
Whole brain and whole spinal cord irradiation in 22 cases and whole brain irradiation in 5 cases. All patients underwent HSCT within 6 months before and after irradiation. Radiotherapy was 3DCRT in all patients. Dose fractionation was 12-40 Gy/6-20 fr.
Twenty-six of the 27 patients underwent intrathecal chemotherapy.
The 22 patients who received CSI had a median overall survival of 13 months and a recurrence-free survival of 11 months, and the sites of recurrence during the observation period were bone marrow in 6 patients, central nervous system in 4 patients, other in 2 patients, and no recurrence in 10 patients.
In a part of CSI irradiated patients, recurrence-free survival of more than 10 years after irradiation was achieved. There was a patient in which the patient died two months after CSI, even though there was no lesion in the spinal cord but intracranial lesion.
In the group that received WBI, one of the four patients who received WBI and intrathecal chemotherapy developed a recurrence in the dural space one month after irradiation and died within three months, and one patient died of CPA of unknown cause six months after irradiation without recurrence.
The other had a recurrence-free survival at 12 years. The remaining patient developed multiple bone metastases 3 months after irradiation and died 4 months after irradiation. One patient who underwent WBI and did not receive intrathecal injection died of myocarditis triggered by infection two months after brain irradiation.
Conclusion
CSI was selected as basic planned salvage radiotherapy for CNS recurrent hematopoietic tumors in the institute.
Specific indicators for choosing between CSI and WBI for radiotherapy of CNS recurrent hematopoietic tumors were not found in this review.
Although WBI was performed in only 5 cases, only 1 case of CNS recurrence occurred, suggesting that WBI may be effective enough to prevent CNS recurrence when intrathecal injection is performed.
Although both a small number, there were a few patients of presumed excessive irradiation field among the CSI cases, and a few patients of suspected insufficient irradiation field among the WBI cases.