Therapeutic management of primary central nervous system lymphoma

Abstract

Once considered to be a rare tumor, primary CNS lymphoma (PCNSL) now afflicts approximately 300 people in Japan each year. PCNSL's completely regress with corticosteroid or irradiation, but soon recur. Median survival time of PCNSL patients has been reported to be 10 to 18 months by radiotherapy alone. The current treatment recommendation is systemic high-dose methotrexate followed by whole cranial irradiation treatment. This strategy produces a response rate of 80-90% and an MST of more than 30 months. However, improved survival overshadows treatment efficacy especially in the elderly patients over 60 years of age in whom delayed therapy-related neurotoxicity is observed frequently. Multi-institutional prospective trials will ensure the establishment of a consensus for therapy of this disease based on age and other prognostic factors.