Radiotherapy for newly diagnosed primary central nervous system lymphoma: role and perspective

Alice Thomas; Caroline Houillier; Delphine Antoni; Khe Hoang-Xuan; Carole Soussain; Julian Jacob; Loic Feuvret

doi:10.5603/RPOR.a2023.0028

Radiotherapy for newly diagnosed primary central nervous system lymphoma: role and perspective

Rep Pract Oncol Radiother. 2023 Jun 26;28(2):271-285. doi: 10.5603/RPOR.a2023.0028. eCollection 2023.

Authors

Alice Thomas^{1

2}, Caroline Houillier³, Delphine Antoni¹, Khe Hoang-Xuan³, Carole Soussain⁴, Julian Jacob², Loic Feuvret^{2

5}

Affiliations

¹ Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France.
² Department of Radiation Oncology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, APHP, Paris, France.
³ Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France.
⁴ Department of Hematology, Institut Curie site de Saint-Cloud, France, and INSERM U932 Institut Curie, PSL Research University, Paris, France.
⁵ Department of Radiation Oncology, Hospices Civils de Lyon, Lyon, France.

Abstract

Whole brain radiotherapy (WBRT) has long been a key treatment of newly diagnosed primary central nervous system lymphoma (PCNSL). In the 1990s, the addition of high dose Methotrexate-based induction chemotherapy (HD MTX-based CT) has enabled a drastic improvement in PCNSL patients outcome. However, combined treatment has led to radiation-induced delayed neurotoxicity, especially in older patients. Alternative treatment strategies have been assessed to improve the efficacy and neurotoxicity ratio. Nowadays, in the elderly patients WBRT is widely omitted or deferred, and in younger patients WBRT is challenged by high dose chemotherapy with autologous stem cell transplant (HCT-ASCT) for consolidation treatment after HD MTX-based CT. In this setting, this review is addressed to clinicians with the aim to summarize the role of WBRT in the treatment of newly diagnosed PCNSL and its perspectives.

Keywords: central nervous system; chemotherapy; lymphoma; neurotoxicity; radiotherapy.

Publication types

Review