Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial

• Published in: Neuro-oncology (Charlottesville, Va.) Vol. 19; no. 3; pp. 422 - 429
• Main Authors: Tabouret, Emeline, Houillier, Caroline, Martin-Duverneuil, Nadine, Blonski, Marie, Soussain, Carole, Ghesquières, Herve, Houot, Roch, Larrieu, Delphine, Soubeyran, Pierre, Gressin, Remy, Gyan, Emmanuel, Chinot, Olivier, Taillandier, Luc, Choquet, Sylvain, Alentorn, Agusti, Leclercq, Delphine, Omuro, Antonio, Tanguy, Marie-Laure, Hoang-Xuan, Khe
• Format: Journal Article
• Language: English
• Published: England Oxford University Press (OUP) 01.03.2017; Oxford University Press
• Subjects: Antineoplastic Combined Chemotherapy Protocols; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Central Nervous System Neoplasms; Central Nervous System Neoplasms - drug therapy; Central Nervous System Neoplasms - metabolism; Central Nervous System Neoplasms - pathology; Clinical Investigations; Follow-Up Studies; Human health and pathology; Humans; Life Sciences; Lymphoma, Non-Hodgkin; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - metabolism; Lymphoma, Non-Hodgkin - pathology; Magnetic Resonance Imaging; Magnetic Resonance Imaging - methods; Neoplasm Recurrence, Local; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - metabolism; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Prognosis; Prospective Studies; Survival Rate; magnetic resonance imaging; response criteria; T2-weighted/FLAIR sequences; prognostic factor; primary CNS lymphoma
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/now238

Our aim was to review MRI characteristics of patients with primary CNS lymphoma (PCNSL) enrolled in a randomized phase II trial and to evaluate their potential prognostic value and patterns of relapse, including T2 fluid attenuated inversion recovery (FLAIR) MRI abnormalities. Neuroimaging findings in 85 patients with PCNSL enrolled in a prospective trial were reviewed blinded to outcomes. MRI characteristics and responses according to International PCNSL Collaborative Group (IPCG) criteria were correlated with progression-free survival (PFS) and overall survival (OS). Multivariate analysis showed that objective response at 2 months (P < .001) and at end of treatment (P = .015) were predictors of prolonged OS. Infratentorial location (P = .008) and large (>11.4 cm3) enhancing tumor volume (P = .006) were associated with poor OS and PFS, respectively. Ratio of change in product of largest diameters at early MRI evaluation but not timing of complete response achievement (early vs delayed) was prognostic for OS. Sixty-nine patients relapsed. Relapse in the brain (n = 52) involved an initial enhancing site, a different site, or both in 46%, 40%, and 14% of patients, respectively. At baseline, non-enhancing T2-FLAIR hypersignal lesions distant from the enhancing tumor site were detected in 18 patients. These lesions markedly decreased (>50%) in 16 patients after chemotherapy, supporting their neoplastic nature. Of these patients, 10/18 relapsed, half (n = 5) in the initially non-enhancing T2-FLAIR lesions. Baseline tumor size and infratentorial localization are of prognostic value in PCNSL. Our findings provide evidence that non-enhancing FLAIR abnormalities may add to overall tumor burden, suggesting that response criteria should be refined to incorporate evaluation of T2-weighted/FLAIR sequences.