How would you manage a patient with primary CNS lymphoma who is not a candidate for high-dose methotrexate?

In a patient who absolutely cannot receive chemotherapy due to impaired performance status, what dose would you use for WBRT and what dose would you use for a reduced field boost to the enhancing tumor volume (with margin)? Or, in such a situation, would palliative radiation therapy with WBRT to 30 Gy in 10 fractions be appropriate?

1 Answer

Mednet Member

Radiation Oncology · Washington University School of Medicine

Answered on

This is a relatively rare situation in my experience, but I think WBRT is the second most active agent for PCNSL after high-dose MTX, so if MTX is not possible, I would strongly consider WBRT. Hypothetically, if patient has good PS and you are going for "curative intent", the standard WBRT alone app...

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