Partial-brain radiotherapy for primary central nervous system lymphoma: multi-institutional experience

Area of Science:

• Radiation Oncology
• Neuro-Oncology
• Medical Physics

Background:

• Whole-brain radiotherapy (WBRT) is a standard treatment for primary central nervous system lymphoma (PCNSL).
• Delayed neurotoxicity is a significant concern associated with WBRT.
• Partial-brain radiotherapy (PBRT) with wide margins is being explored for select PCNSL cases.

Purpose of the Study:

• To evaluate the treatment outcomes of PCNSL patients treated with PBRT.
• To compare the efficacy and toxicity of PBRT versus WBRT in PCNSL management.
• To assess the role of PBRT in patients with solitary or few lesions.

Main Methods:

• Retrospective analysis of 24 PCNSL patients treated with PBRT between 2003 and 2014.
• 16 patients received high-dose methotrexate (MTX)-based chemotherapy prior to PBRT.
• Comparison group included 15 patients treated with MTX-based chemotherapy and WBRT.
• Conventional fractionation with a median dose of 54 Gy was employed for PBRT.

Main Results:

• The 3-year overall survival rate was 60% for all PBRT patients and 68% for those receiving MTX + PBRT.
• 3-year progression-free survival rates were 41% (PBRT) and 36% (MTX + PBRT).
• Neurocognitive dysfunction rates were similar between MTX + PBRT (3/16) and MTX + WBRT (4/15) groups (P = 0.68).

Conclusions:

• PBRT appears to be a feasible treatment option for PCNSL, particularly for patients with solitary lesions.
• CNS recurrence rates were comparable between PBRT and WBRT when combined with MTX-based chemotherapy.
• Further research is needed to definitively establish the advantages of PBRT over WBRT in PCNSL treatment.