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Curr Opin Neurol. 2018 Dec;31(6):733-739. doi: 10.1097/WCO.0000000000000619.

Is whole-brain radiotherapy still a standard treatment for primary central nervous system lymphomas?

Author information

1
Department of Neurology, Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum.
2
Department of Hematology and Oncology, Charité University Hospital Berlin, Berlin, Germany.

Abstract

PURPOSE OF REVIEW:

In primary central nervous system lymphomas (PCNSL), optimal therapy remains to be established, and the role of whole-brain radiotherapy (WBRT) is a matter of debate. With radiation alone, transient responses and clinical improvement are frequent, but long-term disease control is exceptional. WBRT has been considered possible consolidation therapy after high-dose methotrexate (HDMTX)-based initial chemotherapy. This strategy has been questioned due to a high risk of delayed neurotoxicity after combined treatment. This review analyses the current role of WBRT in PCNSL.

RECENT FINDINGS:

Neither in retrospective analyses nor in randomized trials, an overall survival benefit with WBRT in addition to HDMTX-based initial chemotherapy could be found. On the other hand, a recent randomized trial did not show superiority of consolidation with high-dose chemotherapy followed by autologous stem-cell transplantation to consolidation WBRT after initial HDMTX-based polychemotherapy. This finding, however, is probably due to an intense initial therapy and to a small number of patients having reached consolidation and randomization to WBRT vs. high-dose chemotherapy followed by autologous stem-cell transplantation.

SUMMARY:

The current role of WBRT in PCNSL is confined to patients who cannot tolerate chemotherapy or have failed it. WBRT should not routinely be used for consolidation of HDMTX-based chemotherapy due to lack of evidence of efficacy as additional treatment and due to a high risk of neurotoxicity.

PMID:
30300241
DOI:
10.1097/WCO.0000000000000619
[Indexed for MEDLINE]

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