title: Is there a role for radiotherapy in the primary management of primary central nervous system lymphoma? A single-centre case series.
abstract: OBJECTIVE
  In recent years, the optimum primary management of primary central nervous system lymphoma (PCNSL) has evolved from combined modality chemoradiotherapy to chemotherapy alone. We describe a single-centre case series of PCNSL with a view to assessing the role of radiotherapy in primary disease management.
  
  
  METHODS
  West of Scotland PCNSL cases between 2001 and 2010 were identified by neuropathology. Observational data were collected retrospectively from case notes and electronic systems.
  
  
  RESULTS
  Forty-nine patients fulfilled the eligibility criteria. The median age was 61 years. Chemotherapy with a view to consolidation radiotherapy on completion was delivered to 61% (n = 30). Regimens varied, but were generally methotrexate-based. Chemotherapy was discontinued prematurely in 80% (n = 24) due to progressive disease (n = 12), intolerable toxicity (n = 7) or death (n = 4). In all patients who progressed or did not tolerate chemotherapy, treatment was changed to immediate salvage radiotherapy; modal irradiation was 40 Gy. Radiotherapy alone was delivered to those not suitable for chemotherapy (18%, n = 9) and best supportive care to those with poor performance status (18%, n = 9). The overall median survival was 8 months. In those receiving single modality radiotherapy or chemotherapy, the median survival was 5 and 8 months, respectively. For those completing chemoradiotherapy in its entirety, 3 year survival was 100%; in groups receiving salvage radiotherapy despite progressive disease or chemotherapy toxicity, moderate survival was maintained with immediate radiotherapy with 3 year survival rates of 33 and 60%, respectively.
  
  
  CONCLUSIONS
  Although chemotherapy alone remains the optimal treatment of PCNSL, out with clinical trials only a minority of patients complete chemotherapy due to toxicity and disease progression; in such patients, immediate salvage radiotherapy provides an effective and safe alternative with maintenance of good outcomes.
authors.affiliation: The Beatson, West of Scotland Cancer Centre, Glasgow, UK. rebeccamuirhead@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Muirhead
authors.forename: E C
authors.initials: EC
authors.lastname: Murray
authors.forename: S L
authors.initials: SL
authors.lastname: Bell
authors.forename: W
authors.initials: W
authors.lastname: Stewart
authors.forename: A
authors.initials: A
authors.lastname: James
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D016399:Lymphoma, T-Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016879:Salvage Therapy; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D014750:Vincristine; D008727:Methotrexate