Radiation is a consolidative or salvage treatment option for primary CNS lymphoma (PCNSL). RT for PCNSL often involves whole brain radiation, but we know this can result in neurotoxicity. This study compared outcomes from a German neuro-oncology registry of patients treated with whole brain versus focal RT for PCNSL. It included 151 patients with PCNSL (88.3% had DLBCL) who received RT at any point in their treatment. Most (49%) received RT in the salvage setting, 33% received consolidative RT, and 18% received palliative RT. The majority were treated with WBRT (81.4%) and the rest with focal RT. Similar proportions of patients receive WBRT or focal RT in each of the clinical scenarios listed above. As expected, those who received consolidative RT had longer median OS than the other scenarios (30.9 v 9.7 mo). When all of the clinical scenarios were pooled, median OS was significantly longer in those who received focal RT (67.6 v 20.1 mo). In the primary setting (consolidation or RT alone), focal RT was also associated with numerically longer median OS (44 v 11.4 mo). In the salvage setting, median OS was significantly longer with focal RT (8.2 v 3.6 mo). In multivariable analysis, focal RT was still associated with better survival. Granted, there was likely selection bias towards favorable characteristics in those selected for focal RT. | Heider, Radiat Oncol 2025
