title: Utility of post-therapy brain surveillance imaging in the detection of primary central nervous system lymphoma relapse.
abstract: The optimal follow-up strategy for primary central nervous system lymphoma (PCNSL) patients after first-line therapy is unclear. The goal of this study is to determine the utility of planned brain surveillance imaging in the detection of relapse in a retrospective cohort of PCNSL patients.
  
  
  
  Patients were consecutive PCNSL cases treated in Leon Berard Cancer Centre, Lyon, France, from 1985 to 2011. Histology was diffuse large B-cell lymphoma in 94%. Patients were treated by methotrexate (92%) and cytarabine (63%) based-chemotherapy followed by radiotherapy for 108 patients (51%). Clinical records were reviewed for details at relapse and relationship to planned imaging. The imaging follow-up strategy was performed according to each treating physicians.
  
  
  
  Among 209 PCNSL patients, 127 complete response patients entered in post-treatment observation and 63 (50%) subsequently relapsed. Among the 125 evaluable patients, the majority of relapses (N = 49, 80%) was asymptomatic and identified before the planned brain imaging. Surveillance imaging detected relapses before symptoms in 12 patients who entered in post-therapy observation (10%). The median number of brain imaging during the follow-up was 7 (0-13). A total of 819 MRI/CT-scan were performed leading to the detection of 12 asymptomatic relapses. The one year OS rates were 41% and 58% for symptomatic and non-symptomatic relapses, respectively (P = 0.21).
  
  
  
  The majority of PCNSL relapses occurred outside planned follow-up with no difference in patient outcome between symptomatic and asymptomatic relapses. The role of brain imaging for the detection of relapses in the follow-up of PCNSL patients remains to be clarified.
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Fossard
authors.affiliation: Centre Léon Bérard, Department of Statistics, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Ferlay
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Nicolas-Virelizier
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rey
authors.affiliation: Hopital Neurologique, Department of Neurology, Université Claude Bernard Lyon 1, Bron, France.
authors.forename: François
authors.initials: F
authors.lastname: Ducray
authors.affiliation: Hopital Neurologique, Department of Neurosurgery, Université Claude Bernard Lyon 1, Bron, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Jouanneau
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Faurie
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Amine
authors.initials: A
authors.lastname: Belhabri
authors.affiliation: Centre Léon Bérard, Department of Radiotherapy, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Sunyack
authors.affiliation: Centre Léon Bérard, Department of Pathology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chassagne-Clément
authors.affiliation: Centre Léon Bérard, Department of Radiology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Thiesse
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sebban
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Biron
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.affiliation: Centre Léon Bérard, Department of Hematology, Université Claude Bernard Lyon 1, Lyon, France; Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France. Electronic address: herve.ghesquieres@chu-lyon.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Ghesquières
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage
chemical_list: D003561:Cytarabine; D000069283:Rituximab; D008727:Methotrexate
keywords: CNS lymphoma; Imaging; Relapse; Surveillance