Dr. Rico Liu Consultant, Department of Clinical Oncology, Queen Mary Hospital Honorary Clinical Associate Professor, Department of Clinical Oncology, The.

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Presentation transcript:

Dr. Rico Liu Consultant, Department of Clinical Oncology, Queen Mary Hospital Honorary Clinical Associate Professor, Department of Clinical Oncology, The University of Hong Kong Deputy Hospital Chief Executive, Queen Mary Hospital BTG 2013 Feb 2013

Points for discussion Effects of radiation Radiotherapy is not for everyone but for whom and when The role of new technology

Effects of radiation External Radiotherapy High energy Xray Photon- Gama ray- from radioactive decay, e.g. Colbert High energy particles Electron Proton Brachytherapy Systemic radiotherapy apoptosis

Effects of therapeutic radiation

Normal tissue tolerance Milano et al., Semin Radiat Oncol. 17 (2007):

Treatment improves survival Median survival (mo) Untreated~2 WBRT alone~12 Chemotherapy follows by WBRT ~ 48 Henry JM et al. Cancer 34: 1293, 1974 Nelson DF et al. IJROBP Volume 23, Issue 1, 1992, Pages 9–17 Ferreri AJ et al. Ann Oncol Aug;11(8):927-37

PCNSL: Radiotherapy alone RTOG 8315 Phase II study of WBRT 40Gy + 20Gy boost N = 41 Overall median survival 12.2 months Benefit of boost doubtful: disease recurrence frequently occurred in the boosted field, survival no better than previous study without use of boost Ocular involvement: 36Gy to both eyes (or Rx with high dose MTX) Nelson DF et al. IJROBP Volume 23, Issue 1, 1992, Pages 9–17

PCNSL: Chemo + radiotherapy CR 58%, PR 36% (Overall RR 94%) Overall survival 37 months 15% ( 12 patients) developed severe delayed neurologic toxicity 8 out of 12 died ( 5/8 from the group > 60 years of age and 3/8 from < 60 years of age)

Delayed neurotoxicity is worse for elderly patients Omuro AM et al. Arch Neurol Oct;62(10):

G-PCNSL-SG-1 trial

Not enough evidence to forgo WBRT Limitations of the trial Low statistical power High protocol violations High rate of lost to follow up Small sample size in the analysis of neurotoxicity

Lower dose of RT for patients with CR

WBRT- set up

Therapeutic management of PCNSL Ferreri A J M Blood 2011;118: Role of radiotherapy

The role of new technology Neuro Oncol (August 2009) 11 (4):

Summary PCNSL is rare Chemotherapy +/- radiotherapy offer the best survival Delayed neurotoxicity is common and can cause major disability and death Reduce risk of delayed neurotoxicity lower consolidation dose for patients <60 defer WBRT for those older patients >60 Radiotherapy remains an effective treatment for patients considered not suitable for chemotherapy

Thank You