Research article
Role of Whole Brain Radiotherapy in Patients of Primary Central Nervous Lymphoma in the Era of High Dose Methotrexate-Based Chemotherapy – A Single Institution Retrospective Audit
Yadav BS* and Gade VKV
Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
*Corresponding author:Budhi Singh Yadav, Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Article Information: Submission: 15/01/2025; Accepted: 07/02/2025; Published: 14/02/2025
Copyright: © 2025 Yadav BS, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Introduction: Primary central nervous system lymphoma (PCNSL) is an aggressive form of non-Hodgkin lymphoma that primarily affects the brain and its surrounding structures. The introduction of high-dose methotrexate-based chemotherapy (HD-MTX) has led to more individualized treatment approaches based on patient and disease characteristics.
Materials and Methods: This retrospective audit was conducted at a tertiary care center in Northern India for PCNSL patients treated between 2015 to 2024. Patient records were anonymized and variables such as age, sex, performance status, comorbidities, and disease characteristics were recorded. Treatment details included chemotherapy regimens and radiotherapy techniques. Survival outcomes were analyzed using Kaplan-Meier methods and univariate and multivariate analyses were performed to identify prognostic factors.
Results: The study cohort comprised 63 patients, 34 patients treated with curative intent and 29 with palliative intent. The mean age of the patients was 54.2 years. Histology was diffuse large B-cell lymphoma in all patients exceptin one with plasmablastic lymphoma. Among the patients treated with curative intent, 55.8% received HD-MTX-based chemotherapy and WBRT, while 32.3% received HDMTX chemotherapy alone. Median overall survival (OS) and progression-free survival (PFS) in patients treated with curative intent and palliative intent was 39 months vs. 5 months (p<0.0001), and 37 months vs. 5 months (p<0.0001), respectively. On univariate analysis poor performance status at diagnosis was a significant predictor of worse survival outcomes (p<0.00001). In patients receiving WBRT, neurological function scale (NFS) improved in 8.5%, remained stable in 82.5%, and worsened in 21.3%. Importantly, no correlation was found between the delivery of radiotherapy and changes in NFS (p=0.08).
Conclusion: This audit demonstrates that WBRT remains an important component of PCNSL management along with HD-MTX regimen. Despite advancements in chemotherapy, WBRT continues to play a crucial role in consolidating treatment outcomes for PCNSL patients.
Materials and Methods: This retrospective audit was conducted at a tertiary care center in Northern India for PCNSL patients treated between 2015 to 2024. Patient records were anonymized and variables such as age, sex, performance status, comorbidities, and disease characteristics were recorded. Treatment details included chemotherapy regimens and radiotherapy techniques. Survival outcomes were analyzed using Kaplan-Meier methods and univariate and multivariate analyses were performed to identify prognostic factors.
Results: The study cohort comprised 63 patients, 34 patients treated with curative intent and 29 with palliative intent. The mean age of the patients was 54.2 years. Histology was diffuse large B-cell lymphoma in all patients exceptin one with plasmablastic lymphoma. Among the patients treated with curative intent, 55.8% received HD-MTX-based chemotherapy and WBRT, while 32.3% received HDMTX chemotherapy alone. Median overall survival (OS) and progression-free survival (PFS) in patients treated with curative intent and palliative intent was 39 months vs. 5 months (p<0.0001), and 37 months vs. 5 months (p<0.0001), respectively. On univariate analysis poor performance status at diagnosis was a significant predictor of worse survival outcomes (p<0.00001). In patients receiving WBRT, neurological function scale (NFS) improved in 8.5%, remained stable in 82.5%, and worsened in 21.3%. Importantly, no correlation was found between the delivery of radiotherapy and changes in NFS (p=0.08).
Conclusion: This audit demonstrates that WBRT remains an important component of PCNSL management along with HD-MTX regimen. Despite advancements in chemotherapy, WBRT continues to play a crucial role in consolidating treatment outcomes for PCNSL patients.
Keywords:Primary Central Nervous System; Lymphoma; Chemotherapy; Radiotherapy