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Guan J, Lin W, Liu W, Hui D. Primary central nervous system extranodal NK/T-cell lymphoma, nasal type with CD20 expression: Case report and review of the literature. Neuropathology 2024; 44:222-229. [PMID: 37963650 DOI: 10.1111/neup.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
Primary central nervous system (PCNS) extranodal NK/T-cell lymphoma, nasal type (ENKTCL), is an exceedingly rare tumor. To the best of our knowledge, only 27 cases and only one reported aberrant CD20 expression have been documented in the literature. Here we present a second case of PCNS ENKTCL with aberrant CD20 expression in a 43-year-old immunocompetent Chinese female. The patient presented with tremors, weakness in the right upper limb, and a slow reaction. Magnetic resonance imaging revealed multiple brain lesions. A histological examination revealed a diffuse distribution of intermediate-sized pleomorphic lymphocytes with angiocentric growth. The tumor cells expressed CD2, CD3, CD56, T-cell intracellular antigen-1, granzyme B, and Epstein-Barr virus-encoded RNAs (EBERs), with additional partial and weak CD20 and CD30 expression. Despite a confirmatory pathological diagnosis, the patient refused treatment and was discharged, ultimately dying from the disease. In the literature review, the clinical, immunohistochemical, EBERs, treatment, and prognostic features of PCNS ENKTCL were summarized. Although PCNS ENKTCT is extremely rare, it does occur and should always be included in differential diagnoses. CD20 expression should be evaluated routinely with relevant markers. The accumulation of cases is crucial for developing an effective treatment strategy for this rare and aggressive malignancy.
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Affiliation(s)
- Jiexia Guan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weizhen Lin
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weimin Liu
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dayang Hui
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Shibata A, Yamaguchi F, Sasaki K, Yokobori S, Morita A. Primary Central Nervous System Lymphoma in a Patient with Down Syndrome. J NIPPON MED SCH 2023; 90:346-350. [PMID: 35644559 DOI: 10.1272/jnms.jnms.2023_90-502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intracranial tumors are rare in persons with Down syndrome. Although germ cell tumors and gliomas have been reported in Down syndrome, primary central nervous system lymphoma (PCNSL) has not. We report a case of PCNSL in a 48-year-old man with Down syndrome and no history of malignant tumors. He visited our hospital for evaluation of left hemiparesis and gait disturbance. A thorough examination revealed brain tumors, and analysis of a biopsy specimen of the tumor confirmed a diagnosis of PCNSL. The final pathological diagnosis was diffuse large B-cell lymphoma of the central nervous system. Chemotherapy with rituximab, methotrexate, procarbazine, and vincristine was administered, and whole-brain irradiation was planned in conjunction with chemotherapy. It is unclear whether chromosomal abnormalities related to Down syndrome were involved in the development of PCNSL. Further molecular biological analysis may clarify the mechanism of combined Down syndrome and PCNSL.
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Affiliation(s)
- Ami Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Fumio Yamaguchi
- Department of Neurosurgical Surgery, Nippon Medical School
- Department of Neurosurgery for Community Health, Nippon Medical School
| | - Kazuma Sasaki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Akio Morita
- Department of Neurosurgical Surgery, Nippon Medical School
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3
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David K, Davis ME. Primary Central Nervous System Lymphoma: Treatment and Nursing Management of Immunocompetent Patients. Clin J Oncol Nurs 2021; 25:439-448. [PMID: 34269342 DOI: 10.1188/21.cjon.439-448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare primary brain tumor. Because of its rarity and the increasing incidence rates as the U.S. population ages, it is important for nurses to understand the unique needs of patients and their caregivers during the disease continuum. OBJECTIVES This article provides an overview of the treatment and nursing management of immunocompetent patients with PCNSL. METHODS An extensive examination of the current literature, including incidence, diagnosis, treatment, and implications for nursing, was performed. FINDINGS Nurses play a vital role in caring for patients with PCNSL and addressing their unique needs. Nurses should concentrate on early recognition and comprehensive management of neurologic symptoms. This includes patient and caregiver education and diligent implementation of treatment strategies, as well as maximizing quality of life.
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Li D, Fu F, Lian L. Primary central nervous system extranodal nasal-type natural killer/T-cell lymphoma with CD20 expression. Neuropathology 2017; 38:198-204. [PMID: 29063643 DOI: 10.1111/neup.12438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Dujuan Li
- Department of Pathology; Henan Provincial People's Hospital (People's Hospital of Zhengzhou University); Zhengzhou China
| | - Fangfang Fu
- Department of Radiology; Henan Provincial People's Hospital (People's Hospital of Zhengzhou University); Zhengzhou China
| | - Lifei Lian
- Department of Neurology, Tongji Hospital, Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Park SY, Kim SI, Kim H, Lee Y, Park SH. An Autopsy Case of Epstein-Barr Virus-Associated Diffuse Large B-Cell Lymphoma of the Central Nervous System in an Immunocompromised Host. J Pathol Transl Med 2017; 52:51-55. [PMID: 28774170 PMCID: PMC5784221 DOI: 10.4132/jptm.2017.01.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022] Open
Abstract
Lymphomas arising in the central nervous system (CNS) of immunocompromised hosts are most commonly non-Hodgkin’s lymphomas and are highly associated with Epstein-Barr virus (EBV). Here we report an autopsy case of EBV-associated CNS diffuse large B-cell lymphoma (DLBCL) in a host suffering from systemic lupus erythematosus who underwent immunosuppressive therapy. After autopsy, EBV-associated CNS DLBCL as well as pulmonary mixed aspergillosis and Pneumocystis jirovecii pneumonia were added to the cause of clinical manifestations of complicated pneumonia and cerebral hemorrhage in this immunocompromised patient. In conclusion, complex disease processes were revealed by autopsy in this case, indicating that the clinicopathological correlations observed through autopsy can improve our understanding of disease progression and contribute to the management of similar patients in the future.
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Affiliation(s)
- Sun-Young Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Ik Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hannah Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoojin Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Sun Y, Wang Y, Han S, Xing B, Li H, Zhu Y, Zhou S, Wang X, Xu J, Tao R. Efficacy and safety of pemetrexed on recurrent primary central nervous system lymphomas in China: a prospective study. Onco Targets Ther 2017; 10:2595-2600. [PMID: 28553124 PMCID: PMC5440074 DOI: 10.2147/ott.s134684] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pemetrexed, a new and novel agent for primary central nervous system lymphomas (PCNSLs), has shown to be efficient as a savage therapy for recurrent PCNSLs. However, more studies are needed. A prospective study was performed on 17 recurrent PCNSL patients with pemetrexed at Shandong Tumor Hospital in China to assess the efficacy and safety of pemetrexed for recurrent PCNSL patients. MATERIALS AND METHODS The medical records and imaging data on all the cases of recurrent PCNSL patients with pemetrexed in our study were collected during August 2012 and April 2015. Folic acid, B12, and dexamethasone were used to induce toxicities related to pemetrexed. Patients were treated with pemetrexed at a dose of 900 mg/m2 intravenously every 3 weeks, and one cycle consists of 6 weeks. RESULTS A total of 17 cases of recurrent PCNSL patients were enrolled in our study, including 10 males and 7 females with a median age of 66.2 years (ranging from 35 to 81). After the treatment, five cases had complete remission, with partial remission in five cases, stable disease in four cases, and progressive disease in three cases. Consequently, the overall response rate was 58.8%, and the disease control rate was 82.4%. The median overall survival was 7.8 months (95% confidence interval: 5.9-9.6 months) in the study of recurrent PCNSL patients. CONCLUSION This study has been the first clinical trial that applied pemetrexed to treat recurrent PCNSL patients in China, and results indicated that chemotherapy using large pemetrexed may become an effective treatment for PCNSL recurrence with modest toxicity.
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Affiliation(s)
- Yi Sun
- School of Medicine and Life Sciences, University of Jinan, Shandong Academy of Medical Sciences.,Department of Neurosurgery, Shandong Cancer Hospital affiliated to Shandong University.,Department of Neurosurgery, The Sixth People's Hospital of Jinan
| | - Yong Wang
- Department of Neurosurgery, Shandong Cancer Hospital affiliated to Shandong University
| | - Shaolong Han
- Department of Neurosurgery, The Sixth People's Hospital of Jinan
| | - Bo Xing
- Department of Neurosurgery, The Sixth People's Hospital of Jinan
| | - Hong Li
- Department of Ophthalmology and Otolaryngology, The Sixth People's Hospital of Jinan, Jinan City, Shandong Province, People's Republic of China
| | - Yufang Zhu
- Department of Neurosurgery, Shandong Cancer Hospital affiliated to Shandong University
| | - Shizhen Zhou
- Department of Neurosurgery, Shandong Cancer Hospital affiliated to Shandong University
| | - Xiuhua Wang
- Department of Neurosurgery, Shandong Cancer Hospital affiliated to Shandong University
| | - Jun Xu
- Department of Neurosurgery, Shandong Cancer Hospital affiliated to Shandong University
| | - Rongjie Tao
- Department of Neurosurgery, Shandong Cancer Hospital affiliated to Shandong University
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Enblad G, Martinsson G, Baecklund E, Hesselager G, Sundström C, Amini RM, Hagberg H. Population-based experience on primary central nervous system lymphoma 2000-2012: the incidence is increasing. Acta Oncol 2017; 56:599-607. [PMID: 28084866 DOI: 10.1080/0284186x.2016.1270465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Primary central nervous system lymphomas (PCNSL) are rare lymphomas with a poor prognosis. Recently, an increased incidence has been reported. The present study is a population-based study of all patients with PCNSL in the Uppsala/Örebro region of middle Sweden. PATIENTS AND METHODS All patients diagnosed with a PCNSL at Uppsala University Hospital 2000-2012 were identified. Altogether, 96 patients (50 women and 46 men) were included. The median age at diagnosis was 66 years (17-95). RESULTS There was a statistically significant increase in age-standardized incidence during the study period, 30 patients were diagnosed in the first half and 66 in the second half of the period. No patient had an HIV-infection. Two patients had undergone kidney transplantation and were treated with immunosuppressive drugs. A high proportion of the patients, 29%, had a history of an autoimmune or inflammatory disease. The prognosis was poor with a median survival of only four months. In the 70 (73%) patients treated with curative intention the median survival was 12 months. Patients treated with high-dose methotrexate, radiotherapy and/or temozolomide appeared to have a better survival. There was no improvement in survival during the study period or after the introduction of rituximab. There also was no difference in any of the analyzed variables that could explain the increased incidence. CONCLUSION In this population-based study we could confirm the previously described increased incidence of PCNSL. The prognosis remains poor despite the inclusion of treatment with rituximab during the study period. A high proportion of the patients had a history of an autoimmune or inflammatory disease not previously described but there was no increase during the study period.
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Affiliation(s)
- Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| | - Gustaf Martinsson
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
| | - Eva Baecklund
- Department of Medical Sciences, Uppsala University, Sweden
| | | | - Christer Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Rosie-Marie Amini
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Hans Hagberg
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala University, Sweden
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Nieto K, Gordon LI, Raizer J. Bevacizumab for recurrent primary central nervous system lymphoma: a new treatment? Neuro Oncol 2016; 17:1648-9. [PMID: 26541631 DOI: 10.1093/neuonc/nov246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karina Nieto
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (K.N., J.R.); Department of Medicine (Hematology/Oncology), Northwestern University, Feinberg School of Medicine, Chicago, Illinois (L.I.G., J.R.); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (L.I.G., J.R.)
| | - Leo I Gordon
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (K.N., J.R.); Department of Medicine (Hematology/Oncology), Northwestern University, Feinberg School of Medicine, Chicago, Illinois (L.I.G., J.R.); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (L.I.G., J.R.)
| | - Jeffrey Raizer
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (K.N., J.R.); Department of Medicine (Hematology/Oncology), Northwestern University, Feinberg School of Medicine, Chicago, Illinois (L.I.G., J.R.); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois (L.I.G., J.R.)
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Siasios I, Fotiadou A, Fotakopoulos G, Ioannou M, Anagnostopoulos V, Fountas K. Primary Diffuse Large B-Cell Lymphoma of Central Nervous System: Is Still Surgery an Unorthodox Treatment? J Clin Med Res 2015; 7:1007-12. [PMID: 26566417 PMCID: PMC4625808 DOI: 10.14740/jocmr2376w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 01/08/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is characterized as an extra-nodal non-Hodgkin lymphoma which develops from the neuraxis. The purpose was to report a case of a patient with a supra-tentorial tumor who underwent subtotal resection of his tumor as his biopsy was not indicative of a PCNSL tumor and had uneventful recovery until his last follow-up. A 42-year-old man was admitted to our department for generalized epileptic seizures. CT and MRI examinations revealed a tumor in his right parietal-occipital lobe that was surrounded by edema and was enhancing after gadolinium administration. The patient underwent a navigation-assisted parieto-occipital craniotomy and posterior parietal transcortical approach for tumor biopsy which was not indicative of PCNSL tumor. The surgical team decided to remove the tumor on site. Histological analysis of the resected specimen showed primary diffuse large B-cell lymphoma. Combined chemotherapy and radiation therapy was applied to the patient, and at his last follow-up (16 months), he is tumor free. In our case as in several other studies during the last decade, the outcome after the surgical resection of a PCNSL tumor in combination to radiation and chemotherapy was unexpectedly good. The role of surgery probably should be reconsidered for single lesion PCNSL tumors.
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Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | - Aggeliki Fotiadou
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | - George Fotakopoulos
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | - Maria Ioannou
- Department of Pathology, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | | | - Konstantinos Fountas
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
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Sasaki T, Nakayama T, Kitamura M, Kakuta Y, Imafuku I. [Case of 55-year-old female with primary central nervous system lymphoma, presenting with brain and eye lesions and long-term relapsing/remitting course]. Rinsho Shinkeigaku 2015; 55:567-72. [PMID: 26156255 DOI: 10.5692/clinicalneurol.cn-000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of a 55-year-old immunocompetent female with primary central nervous system lymphoma (PCNSL). Seven years previously, the patient presented with left facial dysesthesia, and a right thalamus lesion was revealed by brain MRI. Both her dysesthesia and the lesion disappeared spontaneously in six months. One year previously, she noted motor disturbance of the right limbs, and brain MRI revealed lesions in the bilateral basal ganglia and the left internal capsule which gradually increased in size. She was admitted to our hospital owing to the brain MRI findings of a white matter lesion in the left occipital lobe and bilateral optic neuritis. Previously, she had experienced two episodes of steroid-responsive uveitis in her left eye. An inflammatory disease such as multiple sclerosis was initially suspected because of the relapsing/remitting clinical course with a long time interval. Treatment with corticosteroids improved her clinical symptoms and decreased the size of the lesions, but the brain lesions and bilateral optic neuritis recurred within one month. At that time, the β2 microglobulin level in the cerebrospinal fluid was high and the left occipital lobe lesions showed increased 18F-fluoro-deoxyglucose uptake in positron emission tomography and decreased Cho/NAA ratio in 1H-MR spectroscopy. These findings suggested PCNSL. A brain biopsy confirmed the presence of diffuse large B cell lymphoma. Both uveitis and optic neuritis were considered to be caused by intraocular lymphoma associated with PCNSL. Although patients with PCNSL may experience temporary spontaneous remission, our present case suggests that the time interval from remission to relapse can be much longer than generally expected. We suggest that it is necessary to consider PCNSL and perform a brain biopsy on patients presenting with atypical clinical manifestations of an inflammatory disease, even in cases with a long clinical course.
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Lee BS, Juthani RG, Healy AT, Peereboom DM, Recinos VM. Hyperosmolar and methotrexate therapy avoiding surgery in the acute presentation of primary central nervous system lymphoma. Surg Neurol Int 2014; 5:S175-80. [PMID: 25184099 PMCID: PMC4138808 DOI: 10.4103/2152-7806.136741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 06/04/2014] [Indexed: 12/17/2022] Open
Abstract
Background: Primary central nervous system lymphoma (PCNSL) is an aggressive type of extra-nodal non-Hodgkin lymphoma. Without treatment, PCNSL is associated with significant morbidity and mortality, including rapid neurological deterioration. In contrast to other high-grade intracranial neoplasms, PCNSL is considered to have a high response rate to conventional medical therapy, especially in younger patients, and therefore warrants particular attention in terms of nonsurgical treatment. Case Description: We report a case of the medical management of acute deterioration due to rapidly growing PCNSL with mass effect to highlight the efficacy of temporization with hyperosmolar therapy while awaiting the known rapid effects of dexamethasone and methotrexate (MTX) treatment. Surgical intervention was avoided, and tumor response was rapid. The patient had corresponding clinical resolution of symptoms of elevated intracranial pressure with return to neurologic baseline. Conclusions: Despite the evidence that PCNSL responds well to steroids and MTX, the rapidity of onset with which this occurs can vary. In patients presenting with mass effect and rapid neurologic decline, there is little evidence to support medical over surgical intervention. Herein we present an illustrative case of a large PCNSL lesion presenting with rapid decline. With clinical improvement in one day and a 50% reduction in tumor volume over less than seven days, the authors present the specific time frame with which PCNSL responds to medical therapy and a safe strategy for medical temporization.
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Affiliation(s)
- Bryan S Lee
- Department of Neurological Surgery, Burkhardt Brain Tumor and Neuro-Oncology Center, Ohio, Cuyahoga, USA
| | - Rupa G Juthani
- Department of Neurological Surgery, Burkhardt Brain Tumor and Neuro-Oncology Center, Ohio, Cuyahoga, USA
| | - Andrew T Healy
- Department of Neurological Surgery, Burkhardt Brain Tumor and Neuro-Oncology Center, Ohio, Cuyahoga, USA
| | - David M Peereboom
- Cleveland Clinic Foundation, Burkhardt Brain Tumor and Neuro-Oncology Center, Ohio, Cuyahoga, USA
| | - Violette M Recinos
- Department of Neurological Surgery, Burkhardt Brain Tumor and Neuro-Oncology Center, Ohio, Cuyahoga, USA
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12
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Primary natural killer/T-cell lymphoma presenting as leptomeningeal disease. J Neurol Sci 2014; 343:46-50. [DOI: 10.1016/j.jns.2014.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 04/29/2014] [Accepted: 05/06/2014] [Indexed: 11/30/2022]
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13
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Trignani M, Genovesi D, Vinciguerra A, Di Pilla A, Augurio A, Di Tommaso M, Cèfaro GA, Di Nicola M. Parotid glands in whole-brain radiotherapy: 2D versus 3D technique for no sparing or sparing. LA RADIOLOGIA MEDICA 2014; 120:324-8. [PMID: 25033946 DOI: 10.1007/s11547-014-0436-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/12/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Whole-brain radiotherapy is performed as standard therapy in patients with multiple brain metastases and in patients with more favourable prognosis such as lymphoma and small-cell lung carcinoma in the prophylactic setting. Because of the prognosis and the total prescribed dose, the parotid glands are not usually regarded as an organ at risk in whole-brain radiotherapy. Long-term survival can be expected in some of these patients and late toxicity can be observed, becoming essential to evaluate organs at risk, particularly the parotid glands even in metastatic patients. We compared the 2D with 3D technique to evaluate parotid glands involvement and received dose, and coverage of the clinical target volume. MATERIALS AND METHODS Seven patients were considered. The prescribed dose was 30 Gy in ten fractions. On the same day and with the same set-up, all the treatment planning were performed using a 2D and 3D technique. A treatment plan was performed following same technical characteristics as the 2D technique. The parotid glands and whole brain were delineated. Dose-volume statistics were analysed. RESULTS Dose-volume histograms of the parotid glands showed that 2/7 patients (28 %) received a mean dose >20 Gy. We found a lack of coverage of the clinical target volume in 6/7 patients. CONCLUSIONS Planning whole-brain radiotherapy with only the 2D technique involves a risk of including parotid glands in the field and not covering the clinical target volume. The 3D technique should be systematically performed and the parotid glands should be regarded as an organ at risk in whole-brain radiotherapy.
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Affiliation(s)
- Marianna Trignani
- Department of Radiation Oncology, G. D'Annunzio University, SS. Annunziata Hospital, via dei Vestini, 66100, Chieti, Italy
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Martin V, Moyal É, Delannes M, Padovani L, Sunyach MP, Feuvret L, Dhermain F, Noël G, Laprie A. Radiothérapie des tumeurs cérébrales : quelles marges ? Cancer Radiother 2013; 17:434-43. [DOI: 10.1016/j.canrad.2013.07.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 01/15/2023]
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