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Radiation Therapy in Primary Central Nervous System (CNS) Lymphoma

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Radiation Oncology

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Abstract

Primary central nervous system lymphoma (PCNSL) accounts for 2–3% of all primary brain tumors. The majority of PCNSL occur sporadically with an incidence peak in the 5th to 7th decade. The method of choice for the diagnostics and classification of PCNSL is the cranial MRI. Examination results mostly show single supratentorial lesions (in 30–65% of all cases) with contrast-enhancement, and minor necrosis areas and small edema, often localized in the periventricular hemispheres or basal ganglia.

After imaging, stereotactic biopsy should be performed. The application of glucocorticoids before biopsy may alter histopathologic evaluation. In cases of unclear histology, a second biopsy may be performed at tumor regrowth. Due to very good therapeutic effects with chemo- and radiotherapy and the diffuse-growing behavior of PCNSL, surgical therapy is rarely performed and traditionally not advised. With whole brain radiation (WBRT), up to 90% of the patients developed a recurrent disease. HDMTX represents the current most accepted standard treatment. Many protocols combine induction of HDCTX with whole brain radiation therapy. Combination of CTX with WBRT improved OAS to 36.9–60 months, with 50 months in younger and 21 months in elderly patients. Since increased neurotoxicity is assumed to be caused by radiation, multiple protocols tried to defer radiation with the use of a MTX-based induction followed by a high-dose consolidation therapy. Cause for the neurotoxicity is not just radiotherapy, but also the mutations in the blood-brain barrier caused by chemotherapy.

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Authors and Affiliations

  1. Klinik f. Strahlentherapie, Universitätsklinikum Münster, Münster, Germany

    Daniela Trog & Andrea Baehr

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  1. Daniela Trog
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  2. Andrea Baehr
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Correspondence to Daniela Trog .

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Editors and Affiliations

  1. Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany

    Frederik Wenz

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Trog, D., Baehr, A. (2017). Radiation Therapy in Primary Central Nervous System (CNS) Lymphoma. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_28-1

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  • DOI: https://doi.org/10.1007/978-3-319-52619-5_28-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52619-5

  • Online ISBN: 978-3-319-52619-5

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