title: Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial.
abstract: Our aim was to review MRI characteristics of patients with primary CNS lymphoma (PCNSL) enrolled in a randomized phase II trial and to evaluate their potential prognostic value and patterns of relapse, including T2 fluid attenuated inversion recovery (FLAIR) MRI abnormalities.
  
  
  
  Neuroimaging findings in 85 patients with PCNSL enrolled in a prospective trial were reviewed blinded to outcomes. MRI characteristics and responses according to International PCNSL Collaborative Group (IPCG) criteria were correlated with progression-free survival (PFS) and overall survival (OS).
  
  
  
  Multivariate analysis showed that objective response at 2 months (P < .001) and at end of treatment (P = .015) were predictors of prolonged OS. Infratentorial location (P = .008) and large (>11.4 cm3) enhancing tumor volume (P = .006) were associated with poor OS and PFS, respectively. Ratio of change in product of largest diameters at early MRI evaluation but not timing of complete response achievement (early vs delayed) was prognostic for OS. Sixty-nine patients relapsed. Relapse in the brain (n = 52) involved an initial enhancing site, a different site, or both in 46%, 40%, and 14% of patients, respectively. At baseline, non-enhancing T2-FLAIR hypersignal lesions distant from the enhancing tumor site were detected in 18 patients. These lesions markedly decreased (>50%) in 16 patients after chemotherapy, supporting their neoplastic nature. Of these patients, 10/18 relapsed, half (n = 5) in the initially non-enhancing T2-FLAIR lesions.
  
  
  
  Baseline tumor size and infratentorial localization are of prognostic value in PCNSL. Our findings provide evidence that non-enhancing FLAIR abnormalities may add to overall tumor burden, suggesting that response criteria should be refined to incorporate evaluation of T2-weighted/FLAIR sequences.
authors.affiliation: APHM, service de Neuro-Oncologie, CHU Timone, Marseille, France.|Aix-Marseille Universite, UMR911, Marseille, France.|APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Emeline
authors.initials: E
authors.lastname: Tabouret
authors.affiliation: APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Houillier
authors.affiliation: Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Martin-Duverneuil
authors.affiliation: Service de Neurologie, Centre Hospitalier de Nancy, Nancy, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Blonski
authors.affiliation: Service d'Hématologie, Institut Curie-René Huguenin, Saint-Cloud, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Soussain
authors.affiliation: Department of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
authors.forename: Herve
authors.initials: H
authors.lastname: Ghesquières
authors.affiliation: Service d'Hématologie Clinique, CHU-Hôpital Pontchaillou de Rennes, Rennes, France.
authors.forename: Roch
authors.initials: R
authors.lastname: Houot
authors.affiliation: Service de Neuro-Oncologie, CHU de Poitiers, Poitiers, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Larrieu
authors.affiliation: Service d'Hématologie, Institut Bergonie, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Soubeyran
authors.affiliation: Hématologie Clinique, Hôpital A Michallon, Grenoble, France.
authors.forename: Remy
authors.initials: R
authors.lastname: Gressin
authors.affiliation: Service d'Hématologie Clinique de Tours, Tours, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gyan
authors.affiliation: APHM, service de Neuro-Oncologie, CHU Timone, Marseille, France.|Aix-Marseille Universite, UMR911, Marseille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chinot
authors.affiliation: Service de Neurologie, Centre Hospitalier de Nancy, Nancy, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Taillandier
authors.affiliation: Service d'Hématologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Choquet
authors.affiliation: APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.|UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.
authors.forename: Agusti
authors.initials: A
authors.lastname: Alentorn
authors.affiliation: Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Leclercq
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Omuro
authors.affiliation: Service de biostatistiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Tanguy
authors.affiliation: APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: Khe
authors.initials: K
authors.lastname: Hoang-Xuan
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
keywords: T2-weighted/FLAIR sequences; magnetic resonance imaging; primary CNS lymphoma; prognostic factor; response criteria