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Radiation Therapy in Primary Lymphoma of the CNS

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Radiation Oncology

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Abstract

Primary central nervous system lymphoma is a rare presentation of extranodal non-Hodgkin’s lymphoma.

The management of primary central nervous system lymphoma (PCNSL) is complicated by the rarity of the disease. Conclusions about treatment have often been taken from single arm phase II trials or retrospective series since there is a lack of prospective randomized studies. The few Phase III trials that have been performed often have not yielded conclusive results since because of problems with study design or conduct. Controversies exist regarding the optimum induction chemotherapeutic regimen, the role (and dose) of whole brain radiation, or autologous bone marrow transplant as consolidative therapy.

Historically, whole brain radiation therapy (WBRT) was the primary treatment for PCNSL. Early studies reported an improvement of survival with the addition of induction chemotherapy, but neurological sequelae were a risk with the combination of WBRT and high-dose methotrexate-containing chemotherapy regimens. Clinical studies in PCNSL have focused on improving the percentage of complete responders to induction therapy by testing various chemotherapy regimens and reducing the morbidity of consolidation whole brain radiation either by reducing the radiation dose or deferring radiation consolidation. While a number of studies have deferred WBRT until the time of relapse in patients who are complete responders to chemotherapy, at the present time, no phase III trial has yet definitively proven that WBRT can be eliminated from the management of PCNSL, and so the role of radiation especially for complete responders to induction chemotherapy remains controversial.

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Authors and Affiliations

  1. FRCPC, Department of Radiation Oncology, London Regional Cancer Program, London, ON, Canada

    Barbara J Fisher

  2. FRCPC, Department of Oncology, Queen’s University, Kingston, ON, Canada

    X. Melody Qu

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  1. Barbara J Fisher
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  2. X. Melody Qu
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Correspondence to Barbara J Fisher .

Editor information

Editors and Affiliations

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

    Frederik Wenz

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Fisher, B.J., Qu, X.M. (2017). Radiation Therapy in Primary Lymphoma of the CNS. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_9-1

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  • DOI: https://doi.org/10.1007/978-3-319-52619-5_9-1

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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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