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

Anna M Laucis; Katherine Selwa; Yilun Sun; Michelle M Kim; Kyle C Cuneo; Theodore S Lawrence; Daniel R Wahl; Larry Junck; Yoshie Umemura

doi:10.1093/nop/npac052

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

Neurooncol Pract. 2022 Jun 22;9(6):536-544. doi: 10.1093/nop/npac052. eCollection 2022 Dec.

Authors

Anna M Laucis¹, Katherine Selwa², Yilun Sun¹, Michelle M Kim¹, Kyle C Cuneo¹, Theodore S Lawrence¹, Daniel R Wahl¹, Larry Junck², Yoshie Umemura²

Affiliations

¹ Department of Radiation Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
² Department of Neurology, University of Michigan Hospital, Ann Arbor, MI, USA.

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 (n = 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, P = .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 (P > .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.

Keywords: central nervous system; lymphoma; temozolomide; whole brain radiotherapy.

© The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: [email protected].