Among patients with newly diagnosed primary central nervous system (CNS) lymphoma, whole brain radiotherapy (WBRT) after induction chemotherapy may lead to inferior clinical outcomes, according to research published in the Journal of Clinical Oncology.

Patients with primary CNS lymphoma have historically been treated with consolidative WBRT. In recent years, however, high-dose chemotherapy plus autologous stem-cell transplantation (ASCT) has shown promise compared with WBRT, although further data are needed in this area. In this analysis, researchers provided data on a previous randomized phase 2 trial comparing these strategies, with a median follow-up of 98 months.

All included patients had newly diagnosed disease and were aged between 18 and 60 years. Patients received either high-dose methotrexate-based induction chemotherapy followed by 40 Gy WBRT or high-dose chemotherapy and ASCT.


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Overall, 53 and 44 patients received WBRT and ASCT, respectively, with induction chemotherapy. The 8-year survival rates in the WBRT and ASCT groups were 39% and 67%, respectively (P =.03). Relapse rates were, furthermore, lower in the ASCT group (hazard ratio, 0.13; P <.001).

After salvage treatment, approximately 33% of patients who relapsed in the WBRT group were alive. Analysis also showed, however, that 5 patients who received ASCT and 4 patients who received WBRT died because of toxicity; the 8-year overall survival rates were also similar (69% and 65%, respectively).

More than half of patients in the WBRT group (52% and 64%) had significant balance and neurocognition deterioration, respectively; these figures were 10% and 13% in the ASCT groups (both P <.001).

“In conclusion, the long-term analysis of the PRECIS trial confirms that conventional 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses, and favors ASCT consolidation in first-line treatment for a better disease control,” the authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Houillier C, Dureau S, Taillandier L, et al. Radiotherapy or autologous stem-cell transplantation for primary CNS lymphoma in patients age 60 years and younger: long-term results of the randomized phase II PRECIS study. J Clin Oncol. 2022;40(32):3692-3698. doi:10.1200/JCO.22.00491