Consolidation therapy with or without WBRT

In a prospective, randomized, phase II trial, 87 patients (median age, 59–66 years) had induction therapy with high-dose methotrexate + high-dose cytarabine + rituximab + procarbazine + vincristine. Afterward, 37 patients had consolidation therapy with low-dose WBRT at 23.4 Gy.[31]

In a prospective, randomized, phase II trial, 87 patients (median age, 59–66 years) had induction therapy with high-dose methotrexate + high-dose cytarabine + rituximab + procarbazine + vincristine. Afterward, 37 patients had consolidation therapy with low-dose WBRT at 23.4 Gy.[31]

With a median follow-up of 55 months, the 2-year intention-to-treat PFS was 78% with low-dose WBRT versus 54% without low-dose WBRT (HR, 0.51; P = .015).[31][Level of evidence B1]

In a prospective, randomized, phase II trial, 87 patients (median age, 59–66 years) had induction therapy with high-dose methotrexate + high-dose cytarabine + rituximab + procarbazine + vincristine. Afterward, 37 patients had consolidation therapy with low-dose WBRT at 23.4 Gy.[31]

Investigator-assessed neurotoxicity was less than 15% in each arm and not significantly different. Another small phase II trial that examined low-dose WBRT at 23.4 Gy also found no increased problems seen on neuropsychological testing.[32,33]

In a prospective, randomized, phase II trial of 97 newly diagnosed patients who received high-dose methotrexate combination therapy for induction, patients were randomly assigned to receive WBRT at 40 Gy versus autologous SCT.[34]

In a prospective, randomized, phase II trial of 97 newly diagnosed patients who received high-dose methotrexate combination therapy for induction, patients were randomly assigned to receive WBRT at 40 Gy versus autologous SCT.[34]

With a median follow-up of 8 years, deterioration of balance was significantly greater for patients who received WBRT versus patients who received autologous SCT (52% vs. 10%, P ≤ .001). Worsening neurocognition was also greater for patients who received WBRT (64% vs. 13%, P < .001).

In a prospective, randomized, phase II trial of 97 newly diagnosed patients who received high-dose methotrexate combination therapy for induction, patients were randomly assigned to receive WBRT at 40 Gy versus autologous SCT.[34]

The 8-year EFS rate was 67% for patients who received autologous SCT versus 39% for patients who received WBRT (HR, 0.13; P < .001). There was no significant difference in OS (69% for autologous SCT vs. 54% for WBRT).[34][Level of evidence B1]

In a prospective, randomized, phase II trial of 97 newly diagnosed patients who received high-dose methotrexate combination therapy for induction, patients were randomly assigned to receive WBRT at 40 Gy versus autologous SCT.[34]

The authors concluded that 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and inferior efficacy.

In a prospective, randomized trial of 551 immunocompetent patients with newly diagnosed primary CNS lymphoma, all patients received induction chemotherapy with six cycles of high-dose methotrexate (4 g/m2) with or without ifosfamide. After chemotherapy was completed, responders were randomly assigned to receive either WBRT (45 Gy) or no treatment for complete-response patients and cytarabine for partial-response patients.[35]

In a prospective, randomized trial of 551 immunocompetent patients with newly diagnosed primary CNS lymphoma, all patients received induction chemotherapy with six cycles of high-dose methotrexate (4 g/m2) with or without ifosfamide. After chemotherapy was completed, responders were randomly assigned to receive either WBRT (45 Gy) or no treatment for complete-response patients and cytarabine for partial-response patients.[35]

There was no statistical difference in median OS at 32.4 months for patients who received WBRT versus at 37.1 months for those who did not receive WBRT (HR, 1.06; 95% CI, 0.80–1.40; P = .71).[35][Level of evidence A1]

In a prospective, randomized trial of 551 immunocompetent patients with newly diagnosed primary CNS lymphoma, all patients received induction chemotherapy with six cycles of high-dose methotrexate (4 g/m2) with or without ifosfamide. After chemotherapy was completed, responders were randomly assigned to receive either WBRT (45 Gy) or no treatment for complete-response patients and cytarabine for partial-response patients.[35]

Treatment-related neurotoxic effects were significantly worse in the WBRT arm.

In a prospective, randomized trial, 410 immunocompetent patients with newly diagnosed primary CNS lymphoma were scheduled to receive high-dose methotrexate. Patients were randomly assigned to receive either WBRT or no radiation therapy.[36]

In a prospective, randomized trial, 410 immunocompetent patients with newly diagnosed primary CNS lymphoma were scheduled to receive high-dose methotrexate. Patients were randomly assigned to receive either WBRT or no radiation therapy.[36]

In the intent-to-treat population, WBRT was associated with longer PFS at 15.4 months versus 9.9 months (HR, 0.79; 95% CI, 0.64–0.98; P = .034). There was no difference in OS at 32.4 months versus 36.1 months (HR, 0.98; 95% CI, 0.79–1.26; P = .98).[36][Level of evidence B1]

In a prospective, randomized trial, 410 immunocompetent patients with newly diagnosed primary CNS lymphoma were scheduled to receive high-dose methotrexate. Patients were randomly assigned to receive either WBRT or no radiation therapy.[36]

Long-term treatment-related neurotoxic effects were not reported, and the induction chemotherapy would now be considered substandard.