Primary central nervous lymphoma: what is the role for radiotherapy?

• Published in: Cancer radiothérapie Vol. 18; no. 7; pp. 685 - 692
• Main Authors: Bellefqih, S, Mezouri, I, Khalil, J, Bazine, A, Diakité, A, El Kacimi, H, Kebdani, T, Benjaafar, N
• Format: Journal Article
• Language: French
• Published: France 01.11.2014
• Subjects: Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Central Nervous System Neoplasms - therapy; Humans; Lymphoma, Non-Hodgkin - therapy; Methotrexate - therapeutic use; Prognosis; Radiotherapy Dosage; Radiotherapy, Adjuvant; Stem Cell Transplantation; Chemotherapy; Neurotoxicity; Neurotoxicité; Lymphome primitif du système nerveux central; Primary central nervous system lymphoma; Chimiothérapie; Autogreffe de cellules souches; Whole-brain radiotherapy; Autologous stem cell transplantation; Radiothérapie de l’encéphale en totalité
• ISSN: 1769-6658
• DOI: 10.1016/j.canrad.2014.06.025

Primary central nervous system lymphoma is a rare extranodal form of non-Hodgkin lymphoma with an aggressive course and unsatisfactory outcome. Historically, whole-brain radiotherapy was the sole treatment for patients with primary central nervous system lymphoma, with high response rates but typically, this did not result in long-lasting remissions. The addition of high-dose methotrexate-based chemotherapy regimens to whole-brain radiotherapy has significantly improved patients' outcome, but has resulted in a higher incidence of late neurotoxicity, particularly in elderly patients. To date, the role of consolidation radiotherapy is controversial, and some investigators have developed alternative strategies aiming at avoiding immediate irradiation or using a reduced radiotherapy dose to the whole-brain with promising results.