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Sep 28
Education

EDU 30 - Reinvigorating and Expanding the Role for Radiotherapy for Hematological Malignancies of the Central Nervous System

03:00pm - 04:00pm ET
Central Nervous System
Hematologic Malignancies

MODERATOR(S)

Brandon Imber, MD, MS - Memorial Sloan Kettering Cancer Center

session DESCRIPTION

Primary and secondary hematologic malignancies of the central nervous system (CNS) require complex, multidisciplinary management and remain an area of evolving practice. As systemic therapies for hematologic malignancies continue to advance, the incidence and clinical relevance of CNS involvement appear to be increasing, highlighting the CNS as a potential sanctuary site for disease persistence and relapse. Hematologic malignancies are highly radiosensitive, and CNS-directed radiotherapy retains significant activity, including in chemotherapy-refractory settings. Although historical use of higher-dose radiotherapy was limited by neurotoxicity, contemporary data now support the efficacy of lower-dose and more tailored radiotherapy approaches with improved toxicity profiles. In parallel, the emergence of CNS-penetrant systemic therapies — including cellular and immune-based therapies — has created new opportunities for thoughtful integration of radiotherapy. Session Outline 1. Introduction and Background (5 minutes) Overview of primary vs. secondary CNS hematologic malignancies Common disease entities: primary CNS lymphoma, secondary CNS lymphoma, CNS leukemia Contemporary systemic therapy paradigms and implications for RT decision making 2. Primary CNS Lymphoma (15 minutes) Consolidation strategies following methotrexate-based therapy Role of low-dose whole-brain radiotherapy Potential indications for focal radiotherapy Salvage radiotherapy for methotrexate-refractory or progressive disease 3. Secondary CNS Lymphoma (15 minutes) Patterns of CNS involvement, including leptomeningeal disease Radiotherapy strategies for focal and diffuse disease Integration with autologous transplantation and cellular therapies (e.g., CAR T cells) Practical considerations for timing and intent 4. Neuro-Oncology Perspective (15 minutes) Identifying scenarios where radiotherapy adds meaningful benefit Defining chemotherapy-refractory CNS disease Neurocognitive toxicity risks and mitigation strategies Shared decision making with patients 5. Discussion/Questions

learning objectives

  1. Identify contemporary clinical scenarios in which radiotherapy provides meaningful benefit for patients with primary and secondary CNS hematologic malignancies, including consolidation, salvage and symptom-directed settings.
  2. Apply practical frameworks for selecting radiotherapy dose, field design and timing in coordination with modern systemic and cellular therapies while balancing disease control with neurocognitive toxicity risk.

Credits

AMA PRA Category 1 Credits: 1.00

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