title: The role of radiotherapy and intrathecal CNS prophylaxis in extralymphatic craniofacial aggressive B-cell lymphomas.
abstract: To define the role of radiotherapy and intrathecal prophylaxis in extralymphatic craniofacial involvement (ECFI) of aggressive B-cell lymphoma, we analyzed 11 consecutive German High-Grade Non-Hodgkin Lymphoma Study Group trials. ECFI occurred in 290/4155 (7.0%) patients (orbita, 31; paranasal sinuses, 93; main nasal cavity, 38; tongue, 27; remaining oral cavity, 99; salivary glands, 54). In a multivariable analysis adjusted for International Prognostic Index rituximab improved event-free and overall survival both in patients with and without ECFI. Three-year event-free (79% vs 79%; P = .842) and overall survival (86% vs 88%; P = .351) rates were similar in 145 patients receiving and 57 not receiving radiotherapy. Without rituximab, the 2-year cumulative rate of central nervous system (CNS) disease was increased in 205 ECFI patients compared with 2586 non-ECFI patients (4.2% vs 2.8%; P = .038), whereas this was not observed with rituximab (1.6% in 83 ECFI vs 3.4% in 1252 non-ECFI patients; P = .682). In 88 ECFI patients who received intrathecal prophylaxis with methotrexate, the 2-year rate of CNS disease was 4.2% compared with 2.3% in 191 patients who did not (P = .981). In conclusion, rituximab eliminates the increased risk for CNS disease in patients with ECFI. This retrospective analysis does not support intrathecal prophylaxis or radiotherapy to ECFI patients in complete remission/unconfirmed complete remission. These findings should be confirmed in a prospective study.
authors.affiliation: Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;
authors.forename: Niels
authors.initials: N
authors.lastname: Murawski
authors.affiliation: Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;
authors.forename: Gerhard
authors.initials: G
authors.lastname: Held
authors.affiliation: Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany;
authors.forename: Marita
authors.initials: M
authors.lastname: Ziepert
authors.affiliation: Klinikum Landshut, Landshut, Germany;
authors.forename: Barbara
authors.initials: B
authors.lastname: Kempf
authors.affiliation: Universitätsklinikum Ulm, Ulm, Germany;
authors.forename: Andreas
authors.initials: A
authors.lastname: Viardot
authors.affiliation: Klinikum Chemnitz, Chemnitz, Germany;
authors.forename: Mathias
authors.initials: M
authors.lastname: Hänel
authors.affiliation: Medizinische Klinik V, Heidelberg University, Heidelberg, Germany;
authors.forename: Mathias
authors.initials: M
authors.lastname: Witzens-Harig
authors.affiliation: Klinikum Mutterhaus der Borromäerinnen, Trier, Trier, Germany;
authors.forename: Rolf
authors.initials: R
authors.lastname: Mahlberg
authors.affiliation: Klinik für Strahlentherapie, Saarland University Medical School, Hamburg, Germany; and.
authors.forename: Christian
authors.initials: C
authors.lastname: Rübe
authors.affiliation: Klinik für Strahlentherapie, Saarland University Medical School, Hamburg, Germany; and.
authors.forename: Jochen
authors.initials: J
authors.lastname: Fleckenstein
authors.affiliation: Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;
authors.forename: Carsten
authors.initials: C
authors.lastname: Zwick
authors.affiliation: Asklepios-Klinik St. Georg, Hamburg, Germany.
authors.forename: Bertram
authors.initials: B
authors.lastname: Glass
authors.affiliation: Asklepios-Klinik St. Georg, Hamburg, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.affiliation: Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany;
authors.forename: Samira
authors.initials: S
authors.lastname: Zeynalova
authors.affiliation: Klinik Innere Medizin I, Saarland University Medical School, Hamburg, Germany;
authors.forename: Michael
authors.initials: M
authors.lastname: Pfreundschuh
mesh_terms: D000293:Adolescent; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000517:prevention & control; D018572:Disease-Free Survival; D005153:Facial Neoplasms / Q000401:mortality / Q000628:therapy; D005260:Female; D005858:Germany; D006801:Humans; D007278:Injections, Spinal; D016393:Lymphoma, B-Cell / Q000401:mortality / Q000628:therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011878:Radiotherapy; D000069283:Rituximab; D012888:Skull Neoplasms / Q000401:mortality / Q000628:therapy; D015996:Survival Rate
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D008727:Methotrexate