The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal Review

   


Authors: Cederquist, G. Y.; Tringale, K.; Yahalom, J.; Imber, B. S.
Review Title: The contemporary spectrum of radiotherapy for hematologic malignancies involving the central nervous system: From focal therapy to craniospinal
Abstract: The contemporary landscape of systemic therapy options for hematologic malignancies involving the central nervous system (CNS-HM) is rapidly evolving; a key question is how radiotherapy (RT) can be optimally integrated to improve patient outcomes. Historically, use of RT to treat CNS-HM was defined by broad fields and high doses. While effective, this approach raised concerns of potential neurotoxicity which significantly decreased RT utilization. RT was replaced by high-dose, CNS-penetrant, systemic therapies that offered durable control with lower perceived neurotoxic risk. But, as the therapeutic toolbox for CNS-HM expands, so too does the complexity and diversity of potential clinical scenarios where RT should be considered. In this review, we describe both well-established and emerging opportunities for RT integration, emphasizing how dose selection and field design could balance neurotoxicity risk and disease control. We propose an anatomical framework that captures the diverse utilization of RT for CNS-HM and serves as a practical guide for RT volume and dose design. © 2024 Elsevier Inc.
Keywords: event free survival; survival rate; overall survival; lenalidomide; salvage therapy; cancer radiotherapy; primary central nervous system lymphoma; cytarabine; methotrexate; rituximab; neurotoxicity; nuclear magnetic resonance imaging; cancer palliative therapy; progression free survival; radiotherapy dosage; radiotherapy; vincristine; autologous stem cell transplantation; procarbazine; central nervous system tumor; central nervous system neoplasms; temsirolimus; hematologic malignancy; hematologic neoplasms; brain; remission; seizure; neurologic disease; functional status; hematologic disease; myeloma; whole brain radiotherapy; parenchyma; adverse event; craniospinal irradiation; intracranial hypertension; procedures; central nervous system lymphoma; mortality rate; pomalidomide; primary intraocular lymphoma; consolidation chemotherapy; ibrutinib; humans; human; article; median survival time; secondary central nervous system lymphoma; positron emission tomography-computed tomography; central nervous system cancer; chimeric antigen receptor t-cell immunotherapy; tirabrutinib; bridging therapy; altered state of consciousness; brain parenchyma; central nervous system myeloma; hematologic malignancy of the central nervous system
Journal Title: Seminars in Radiation Oncology
Volume: 35
Issue: 1
ISSN: 1053-4296
Publisher: Elsevier Inc.  
Date Published: 2025-01-01
Start Page: 126
End Page: 137
Language: English
DOI: 10.1016/j.semradonc.2024.11.001
PUBMED: 39672637
PROVIDER: scopus
PMCID: PMC11649007
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85209233623&doi=10.1016%2fj.semradonc.2024.11.001&partnerID=40&md5=fac0ee6476bdd96c92c98324c9a621a4
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK authors: Brandon S. Imber -- Source: Scopus
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MSK Authors
  1. Joachim Yahalom
    633 Yahalom
  2. Brandon Stuart Imber
    221 Imber
  3. Gustav Y Cederquist
    36 Cederquist
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