Journal of Neuro-Oncology

, Volume 104, Issue 1, pp 323–330 | Cite as

Primary CNS lymphoma in patients younger than 60: can whole-brain radiotherapy be deferred?

  • Antonio Omuro
  • Luc Taillandier
  • Olivier Chinot
  • Monica Sierra del Rio
  • Charlotte Carnin
  • Marylin Barrie
  • Carole Soussain
  • Marie-Laure Tanguy
  • Sylvain Choquet
  • Veronique Leblond
  • Khe Hoang-Xuan
  • On behalf of the ANOCEF Group (French Neuro-Oncology Association).
Clinical Study – Patient Study


Whole brain radiotherapy (WBRT) has been increasingly omitted as the first treatment of primary central nervous system lymphoma (PCNSL) because of neurotoxicity risks. However, neurotoxicity risks are lower in young (<60 years) patients; deferring WBRT may not be necessary and may compromise disease control. To investigate this question, we report a consecutive series of young (<60 years) PCNSL patients uniformly treated with a response-adjusted approach, with WBRT omitted in patients with chemosensitive disease. Treatment started with induction chemotherapy consisting of methotrexate (3 g/m2), CCNU, procarbazine, methylprednisolone and intrathecal methotrexate, cytarabine, and methylprednisolone. Patients achieving complete response (CR) received five additional chemotherapy cycles and no further treatment. Patients with less than CR were treated on an individual basis, typically with WBRT or high-dose chemotherapy (HDC) with stem cell rescue. Sixty-four patients were included (median age: 47; median KPS: 70). Median progression-free survival (PFS) was 12 months; median overall survival (OS) was 63 months (median follow-up: 108 months). Objective response after induction was 87% (CR: 54%; PR: 33%). To date, salvage WBRT has been given to a total of 27 patients and HDC to 29. Neurotoxicity developed in five patients (none in patients treated with chemotherapy only). Deferring WBRT in chemosensitive patients seems to compromise PFS but not OS. Neurotoxicity was reduced but not eliminated, as salvage WBRT was frequently required. HDC and WBRT were effective salvage treatments. As the objective of treatment in this population is a cure, withholding WBRT may not be the best strategy and deserves further investigation. Ongoing studies are investigating whether upfront treatment with HDC can replace WBRT in this setting.


Primary central nervous system lymphoma Chemotherapy Radiotherapy Neurotoxicity 


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Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Antonio Omuro
    • 1
    • 2
  • Luc Taillandier
    • 3
  • Olivier Chinot
    • 4
  • Monica Sierra del Rio
    • 1
  • Charlotte Carnin
    • 3
  • Marylin Barrie
    • 4
  • Carole Soussain
    • 5
  • Marie-Laure Tanguy
    • 1
  • Sylvain Choquet
    • 1
  • Veronique Leblond
    • 1
  • Khe Hoang-Xuan
    • 1
  • On behalf of the ANOCEF Group (French Neuro-Oncology Association).
  1. 1.AP-HP, Groupe Hospitalier Pitie-Salpetriere, Service de Neurologie Mazarin, et Universite Pierre & Marie Curie Paris VIParisFrance
  2. 2.Department of NeurologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Centre Hospitalier Universitaire de NancyNancyFrance
  4. 4.Centre Hospitalier Universitaire La TimoneMarseilleFrance
  5. 5.Institut Curie-Hopital Rene HugueninSaint CloudFrance

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