| Title |
A prospective phase II trial of response adapted whole brain radiotherapy after high dose methotrexate based chemotherapy in patients with newly diagnosed primary central nervous system lymphoma-analysis of acute toxicity profile and early clinical outcome
|
|---|---|
| Published in |
Journal of Neuro-Oncology, April 2018
|
| DOI | 10.1007/s11060-018-2856-y |
| Pubmed ID | |
| Authors |
Narayan Adhikari, Ahitagni Biswas, Ajay Gogia, Ranjit Kumar Sahoo, Ajay Garg, Ashima Nehra, Mehar Chand Sharma, Suman Bhasker, Manmohan Singh, Vishnubhatla Sreenivas, Rohan Chawla, Garima Joshi, Lalit Kumar, Subhash Chander |
| Abstract |
The treatment of primary CNS lymphoma (PCNSL) comprises high dose methotrexate (HDMTX) based chemotherapy followed by whole brain radiotherapy (WBRT), the major drawback of which is long term neurotoxicity. We intended to assess the feasibility of response adapted WBRT in PCNSL in the Indian setting. We screened 32 patients and enrolled 22 eligible patients with PCNSL from 2015 to 2017 in a prospective phase II trial. The patients underwent five 2-weekly cycles of induction chemotherapy with rituximab, methotrexate, vincristine, procarbazine. Patients with complete response(CR) to induction chemotherapy were given reduced dose WBRT 23.4 Gy/13 fractions/2.5 weeks while those with partial response (PR), stable or progressive disease (SD or PD) were given standard dose WBRT 45 Gy/25 fractions/5 weeks. Thereafter two cycles of consolidation chemotherapy with cytarabine were given. The primary endpoints of the study were assessment of response rate (RR) and progression free survival (PFS). The secondary endpoints of the study were assessment of overall survival (OS), toxicity profile of treatment and serial changes in quality of life and neuropsychological parameters. Out of 19 patients who completed HDMTX based chemotherapy, 10 (52.63%) patients achieved CR, 8 (42.11%) patients had PR and 1 patient had PD. After a median follow-up period of 11.25 months, the estimated median OS was 19 months. The actuarial rates of PFS and OS were respectively 94.1 and 68.2% at 1 year and 50.2 and 48.5% at 2 years. Three patients in reduced dose WBRT arm had recurrence and two of them died of progressive disease, whereas there was no recurrence or disease related death in standard dose WBRT arm. On univariate analysis of PFS, age ≤ 50 years and use of standard dose WBRT (45 Gy) led to significantly improved outcome (p value 0.03 and 0.02 respectively). In patients with PCNSL, reduced dose WBRT after CR to HDMTX based chemotherapy may lead to suboptimal clinical outcome due to higher risk of recurrence, progression and early death. Trial Registration No CTRI/2015/10/006268. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 38 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 38 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 4 | 11% |
| Student > Doctoral Student | 4 | 11% |
| Student > Ph. D. Student | 3 | 8% |
| Student > Master | 3 | 8% |
| Other | 2 | 5% |
| Other | 8 | 21% |
| Unknown | 14 | 37% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 13 | 34% |
| Nursing and Health Professions | 4 | 11% |
| Neuroscience | 4 | 11% |
| Psychology | 1 | 3% |
| Biochemistry, Genetics and Molecular Biology | 1 | 3% |
| Other | 1 | 3% |
| Unknown | 14 | 37% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 April 2018.
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#20,480,611
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Outputs from Journal of Neuro-Oncology
#2,589
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#290,501
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Outputs of similar age from Journal of Neuro-Oncology
#62
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