Randomized phase III study of whole-brain radiotherapy for primary CNS lymphoma
Abstract
Objective:
This is the final report of a phase III randomized study to evaluate whole-brain radiotherapy (WBRT) in primary therapy of primary CNS lymphoma (PCNSL) after a median follow-up of 81.2 months.
Methods:
Patients with newly diagnosed PCNSL were randomized to high-dose methotrexate (HDMTX)–based chemotherapy alone or followed by WBRT. We hypothesized that the omission of WBRT would not compromise overall survival (OS; primary endpoint), using a noninferiority design with a margin of 0.9.
Results:
In the per-protocol population (n = 320), WBRT nonsignificantly prolonged progression-free survival (PFS) (median 18.2 vs 11.9 months, hazard ratio [HR] 0.83 [95% confidence interval (CI) 0.65–1.06], p = 0.14) and significantly PFS from last HDMTX (25.5 vs 12.0 months, HR 0.65 [95% CI 0.5–0.83], p = 0.001), but without OS prolongation (35.6 vs 37.1 months, HR 1.03 [95% CI 0.79–1.35], p = 0.82). In the intent-to-treat population (n = 410), there was a prolongation by WBRT of both PFS (15.4 vs 9.9 months, HR 0.79 [95% CI 0.64–0.98], p = 0.034) and PFS from last HDMTX (19.4 vs 11.9 months, HR 0.72 [95% CI 0.58–0.89], p = 0.003), but not of OS (32.4 vs 36.1 months, HR 0.98 [95% CI 0.79–1.26], p = 0.98).
Conclusion:
Although the statistical proof of noninferiority regarding OS was not given, our results suggest no worsening of OS without WBRT in primary therapy of PCNSL.
Classification of evidence:
This study provides Class II evidence that in PCNSL HDMTX-based chemotherapy followed by WBRT does not significantly increase survival compared to chemotherapy alone. The study lacked the precision to exclude an important survival benefit or harm from WBRT.
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Supplementary Material
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Information & Authors
Information
Published In
Neurology®
Volume 84 • Number 12 • March 24, 2015
Pages: 1242-1248
Copyright
© 2015 American Academy of Neurology.
Publication History
Received: July 24, 2014
Accepted: November 18, 2014
Published online: February 25, 2015
Published in print: March 24, 2015
Authors
Author Contributions
A. Korfel designed and wrote the study protocol, contributed patients to the trial, and wrote and approved the report. E. Thiel designed and wrote the study protocol, contributed patients to the trial, and approved the report. P. Martus performed the statistical analyses and wrote and approved the report. R. Möhle contributed patients to the trial and approved the report. F. Griesinger contributed patients to the trial and approved the report. M. Rauch contributed patients to the trial and approved the report. A. Röth contributed patients to the trial and approved the report. B. Hertenstein contributed patients to the trial and approved the report. T. Fischer contributed patients to the trial and approved the report. T. Hundsberger contributed patients to the trial and approved the report. H.-G. Mergenthaler contributed patients to the trial and approved the report. C. Junghanß contributed patients to the trial and approved the report. T. Birnbaum contributed patients to the trial and approved the report. L. Fischer contributed patients to the trial and approved the report. K. Jahnke contributed patients to the trial and approved the report. U. Herrlinger designed and wrote the study protocol, contributed patients to the trial, and approved the report. P. Roth contributed patients to the trial and approved the report. M. Bamberg designed and wrote the study protocol, was responsible for central review of radiation oncology, and approved the report. T. Pietsch was responsible for central review of neuropathology and approved the report. M. Weller designed and wrote the study protocol, contributed patients to the trial, and wrote and approved the report.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Study Funding
Supported by the German Cancer Aid grant 70-2838-Th.
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