High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial

Abstract

Background: High-dose methotrexate (HDMTX) is considered standard of care for

Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy

“…However, leukoencephalopathy is associated with a risk of neurotoxicity and may severely interfere with cognitive function (2,3). Progressive leukoencephalopathy with cognitive deterioration is associated with a significant decrease in the quality of life (QOL) (4).…”

Primary central nervous system lymphoma: what a neurologist/neurosurgeon should know?

“…Nowadays, RTx is used in two main situations: as palliative treatment, in patients not fit to receive chemotherapy, and as consolidation after high doses of MTX 25 . However, a high incidence of neurotoxicity has been reported in patients receiving radiotherapy, mostly in patients older than 65 years.…”

“…Avoiding post-chemotherapy WBRT in patients with CR after chemotherapy has been studied in a recent phase III prospective trial, and although the data is not definitive, there was no difference in OS 25 .…”

Primary central nervous system lymphoma: the challenge continues

“…Following treatment with eff ective chemotherapy, consolidative radiation therapy reduces the risk of relapse, but has not been proven to enhance survival, and is associated with an increased rate of debilitating neurotoxicity [3,8]. Because of these confounding eff ects, the role of consolidative radiotherapy following chemotherapy has been a matter of ongoing debate, particularly in the treatment of older patients who are at increased risk of radiation-related toxicity [9]. Th is issue was addressed in a recently published, prospective randomized trial [10].…”

“…Th e study demonstrated a statistically signifi cant improvement in progression-free survival when radiation was administered after a complete or partial response to chemotherapy, but there was no statistically signifi cant survival advantage. Concerns over study methodology have led to uncertainty regarding the interpretation of these results [9,11,12]. One approach that may provide a path forward in this disease is the selective use of response-adapted radiotherapy, with low-dose radiotherapy used after a complete response to chemotherapy.…”