Primary Central Nervous System Lymphomas
Radiotherapy (RT) after systemic chemotherapy including high-dose (HD) methotrexate is widely accepted as the standard treatment for primary central nervous system lymphoma (PCNSL). Treatment must consider the blood brain barrier as it characterizes the clinical behavior of PCNSL. For consolidation RT in patients with complete remission (CR) after chemotherapy, 23.4–30 Gy of whole-brain radiotherapy (WBRT) is recommended. For salvage RT in patients with non-CR or recurrent disease (RD) after chemotherapy, 36–45 Gy of WBRT or 30 Gy of WBRT followed by 10–20 Gy of boost irradiation is recommended. The reported 5-year survival rate of PCNSL patients is 30–50%; it is worse than for patients with other extranodal lymphomas. Late neurological toxicity is a major problem in long survivors after HD methotrexate and WBRT. Chemotherapy alone may be considered in elderly PCNSL patients who are at high risk for radiation-induced neurocognitive dysfunction.
KeywordsCentral nervous system lymphoma (PCNSL) Whole-brain radiotherapy (WBRT) Intraocular lymphoma High-dose methotrexate Neurocognitive dysfunction
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