Primary central nervous system lymphoma

Is there still a role for radiotherapy?

Jerome J. Graber, Antonio Omuro

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose of Review: Adding high-dose methotrexate to whole-brain radiotherapy improves survival in primary central nervous system lymphoma. However, the high neurotoxicity rates observed, especially in the elderly, raised interest in exploring other alternatives such as reduced-dose radiotherapy and chemotherapy-only treatments. Recent Findings: Phase II studies suggested that omitting radiotherapy decreases progression-free survival (PFS) but not overall survival. A randomized phase III trial testing chemotherapy with/without radiation found similar results. However, interpretation of that trial has been difficult because of the chemotherapy regimen used (methotrexate with/without ifosfamide), intrinsic methodological problems and lack of neuropsychological evaluation. It also remains unclear whether chemotherapy-only treatments could ultimately result in worse cognitive outcomes in comparison with combined chemotherapy and radiotherapy because the higher rates of relapses could result in additional neurotoxicity from salvage treatments and brain damage by relapsing tumor. Given differences in relapses and neurotoxicity rates according to age, it is also unclear how results apply to younger versus older patients. Summary: Given the lack of better data, omitting radiotherapy currently seems a justifiable choice in routine practice, particularly in the elderly, but the question remains unsettled. Ongoing studies are investigating other consolidation options, including reduced-dose radiotherapy and high-dose chemotherapy with stem-cell rescue, aiming at improving disease control and decreasing neurotoxicity.

Original languageEnglish (US)
Pages (from-to)633-640
Number of pages8
JournalCurrent Opinion in Neurology
Volume24
Issue number6
DOIs
StatePublished - Dec 2011
Externally publishedYes

Fingerprint

Lymphoma
Radiotherapy
Central Nervous System
Drug Therapy
Methotrexate
Recurrence
Salvage Therapy
Ifosfamide
Survival
Brain
Disease-Free Survival
Stem Cells
Radiation
Therapeutics
Neoplasms

Keywords

  • methotrexate
  • neurotoxicity
  • primary central nervous system lymphoma
  • radiation leukoencephalopathy
  • radiation therapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Primary central nervous system lymphoma : Is there still a role for radiotherapy? / Graber, Jerome J.; Omuro, Antonio.

In: Current Opinion in Neurology, Vol. 24, No. 6, 12.2011, p. 633-640.

Research output: Contribution to journalArticle

Graber, Jerome J. ; Omuro, Antonio. / Primary central nervous system lymphoma : Is there still a role for radiotherapy?. In: Current Opinion in Neurology. 2011 ; Vol. 24, No. 6. pp. 633-640.
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