Stereotactic Radiosurgery and Highly Active Antiretroviral Therapy for HIV-Related Primary Central Nervous System Lymphomas: A Prospective Study Analyzing the Efficacy and Safety.

Neurosurgery practice Pub Date : 2023-12-07 eCollection Date: 2024-03-01 DOI:10.1227/neuprac.0000000000000072
Andres M Alvarez Pinzon, Jose Ramon Alonso, Aizik Wolf, Felipe Ramirez-Velandia, Jose E Valerio
{"title":"Stereotactic Radiosurgery and Highly Active Antiretroviral Therapy for HIV-Related Primary Central Nervous System Lymphomas: A Prospective Study Analyzing the Efficacy and Safety.","authors":"Andres M Alvarez Pinzon, Jose Ramon Alonso, Aizik Wolf, Felipe Ramirez-Velandia, Jose E Valerio","doi":"10.1227/neuprac.0000000000000072","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) has been well established and considered a safe alternative for primary central nervous system lymphomas (PCNSLs). However, in HIV-related PCNSL, the use of SRS remains controversial. The purpose of this study was to evaluate the efficacy and safety of SRS in HIV-related PCNSL.</p><p><strong>Methods: </strong>Forty-two adult patients with confirmed PCNSL and no previous radiotherapy or chemotherapy were selected, with 16 receiving Gamma Knife Radiosurgery (GKRS) alone and 26 receiving Highly Active Antiretroviral Therapy (HAART) before GKRS. Follow-up evaluations were conducted at 3, 6, 12, and 24 months post-treatment using clinical and imaging techniques. Statistical analyses were performed using SPSS v22, assessing for new lesions, changes in lesion size, progression-free survival, and overall survival.</p><p><strong>Results: </strong>HAART/GKRS showed a significantly higher rate of complete response compared with the GKRS group, with 53.8% vs 18.8% (<i>P</i> = .048). The mean progression-free survival for the HAART/GKRS group and the GKRS group was 39.7 months and 31.2 months, respectively (<i>P</i> = .0051). Patients with a delayed HAART initiation (>6 months) exhibited an increased burden of T2 white matter lesions and a higher number of large lesions (odds ratio = 1.9, 95% CI = 1.44-2.42, <i>P</i> = .001). However, no significant difference was observed between the two groups regarding radionecrosis.</p><p><strong>Conclusion: </strong>The study highlights the potential benefits of adding HAART to GKRS for patients with PCNSL, leading to improved survival outcomes. An early initiation of HAART was associated with less tumor progression, underscoring the importance of timely administration of HAART in patients with AIDS-related PCNSL.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00072"},"PeriodicalIF":0.0000,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783655/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgery practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1227/neuprac.0000000000000072","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background and objectives: Stereotactic radiosurgery (SRS) has been well established and considered a safe alternative for primary central nervous system lymphomas (PCNSLs). However, in HIV-related PCNSL, the use of SRS remains controversial. The purpose of this study was to evaluate the efficacy and safety of SRS in HIV-related PCNSL.

Methods: Forty-two adult patients with confirmed PCNSL and no previous radiotherapy or chemotherapy were selected, with 16 receiving Gamma Knife Radiosurgery (GKRS) alone and 26 receiving Highly Active Antiretroviral Therapy (HAART) before GKRS. Follow-up evaluations were conducted at 3, 6, 12, and 24 months post-treatment using clinical and imaging techniques. Statistical analyses were performed using SPSS v22, assessing for new lesions, changes in lesion size, progression-free survival, and overall survival.

Results: HAART/GKRS showed a significantly higher rate of complete response compared with the GKRS group, with 53.8% vs 18.8% (P = .048). The mean progression-free survival for the HAART/GKRS group and the GKRS group was 39.7 months and 31.2 months, respectively (P = .0051). Patients with a delayed HAART initiation (>6 months) exhibited an increased burden of T2 white matter lesions and a higher number of large lesions (odds ratio = 1.9, 95% CI = 1.44-2.42, P = .001). However, no significant difference was observed between the two groups regarding radionecrosis.

Conclusion: The study highlights the potential benefits of adding HAART to GKRS for patients with PCNSL, leading to improved survival outcomes. An early initiation of HAART was associated with less tumor progression, underscoring the importance of timely administration of HAART in patients with AIDS-related PCNSL.

立体定向放射外科和高活性抗逆转录病毒治疗hiv相关原发性中枢神经系统淋巴瘤:一项疗效和安全性分析的前瞻性研究。
背景和目的:立体定向放射外科手术(SRS)已经建立并被认为是原发性中枢神经系统淋巴瘤(PCNSLs)的安全替代方案。然而,在hiv相关的PCNSL中,SRS的使用仍然存在争议。本研究的目的是评估SRS治疗hiv相关PCNSL的疗效和安全性。方法:选择42例确诊为PCNSL且既往无放疗或化疗的成人患者,其中16例单独接受伽玛刀放疗(GKRS), 26例在GKRS前接受高效抗逆转录病毒治疗(HAART)。在治疗后3、6、12和24个月采用临床和影像学技术进行随访评估。使用SPSS v22进行统计分析,评估新发病变、病变大小变化、无进展生存期和总生存期。结果:HAART/GKRS组的完全缓解率显著高于GKRS组,分别为53.8%和18.8% (P = 0.048)。HAART/GKRS组和GKRS组的平均无进展生存期分别为39.7个月和31.2个月(P = 0.0051)。延迟HAART起始(bbb6个月)的患者表现出T2白质病变负担增加和大病变数量增加(优势比= 1.9,95% CI = 1.44-2.42, P = 0.001)。然而,两组在放射性坏死方面没有显著差异。结论:该研究强调了PCNSL患者在GKRS中加入HAART的潜在益处,可改善生存结果。早期开始HAART治疗与肿瘤进展较少相关,这强调了及时给予HAART治疗对艾滋病相关PCNSL患者的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信