Abstract
AB079. Whole-brain radiotherapy versus high dose chemotherapy with autologous stem-cell transplantation for consolidation therapy in primary central nervous system lymphoma
Denny Handoyo Kirana1, Felix Wijovi1,2, Vanessa Angelica2, Fernando Dharmaraja2, Julius July3
1Department of Radiation Oncology, Mochtar Riady Comprehensive Cancer Center, Siloam Hospitals Semanggi, South Jakarta, Indonesia;
2Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia;
3Department of Neurosurgery, Siloam Hospitals Lippo Village, Tangerang, Indonesia
Correspondence to: Denny Handoyo Kirana, MD. Department of Radiation Oncology, Mochtar Riady Comprehensive Cancer Center, Siloam Hospitals Semanggi, Lotus Raya Street C10 Number 3, Serenade Lake Gading Serpong, Tangerang Banten 15311, South Jakarta, Indonesia. Email: dennyhandoyo@gmail.com.
Background: Whole brain radiotherapy (WBRT) is commonly used as consolidation therapy in primary central nervous system lymphoma (PCNSL). However, high-dose chemotherapy followed by autologous stem cell transplantation (HD-ASCT) has emerged as an alternative approach for PCNSL. This systematic review aims to assess the efficacy and safety of both treatment modalities.
Methods: The systematic review follows PRISMA guidelines. A comprehensive search strategy identified relevant studies from PubMed, Europe PMC, and Cochrane Library. The following search terms were used: “primary central nervous system lymphoma”, “Autologous Stem Cell Transplantation”, and “whole-brain radiotherapy”. We included randomized controlled trials (RCTs) cohort studies evaluating the use of whole-brain radiotherapy and high-dose chemotherapy followed by autologous stem cell transplantation in the treatment of histologically-confirmed PCNSL. Publications included were limited to English language full texts that were published in the past 10 years. Data extraction & manuscript quality assessment was done by two independent reviewers with a third reviewer to resolve any discrepancy. Primary outcomes include overall survival (OS), progression-free survival (PFS) & treatment related toxicity (TRT). Secondary outcomes were clinical neurological function and performance score assessments. Individual studies were assessed using the Jadad Scale and the Newcastle-Ottawa Scale for observational studies.
Results: We identified 5 studies, consisting of 2 RCTs and 3 cohort studies. After all studies considered, analysis revealed that consolidation therapy with HD-ASCT had a better overall PFS and OS compared to whole-brain radiotherapy (P<0.005). Both groups showed similar TRT with mostly haematological toxicity. Holistically clinical cognitive functions are found to be improved in HD-ASCT Patients and poorer results are exhibited by WBRT patients primarily in executive functions. Performance statuses are scored differently across all studies with slightly preferable results shown in patients treated with HDC-ASCT.
Conclusions: Based on the findings of this systematic review, HDC-ASCT might be a preferable choice of consolidative therapy as shown with better OS, PFS with similar TRT. While WBRT are more feasible and cost-efficient, risks of cognitive impairment and reduced performance status after WBRT should be considered for further treatment choices. Further randomized clinical trials with a similar scoring system are needed.
Keywords: Whole brain radiotherapy (WBRT); primary central nervous system lymphoma (PCNSL); high-dose chemotherapy followed by autologous stem cell transplantation (HD-ASCT); consolidation therapy
Acknowledgments
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab079/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
Cite this abstract as: Kirana DH, Wijovi F, Angelica V, Dharmaraja F, July J. AB079. Whole-brain radiotherapy versus high dose chemotherapy with autologous stem-cell transplantation for consolidation therapy in primary central nervous system lymphoma. Chin Clin Oncol 2024;13(Suppl 1):AB079. doi: 10.21037/cco-24-ab079
