Top Line: Does it make sense to de-esclate rather than eliminate whole brain radiation (WBRT) in the modern treatment paradigm of primary central nervous system (CNS) lymphoma?
The Study: In a randomized phase II study, 91 patients with newly diagnosed primary CNS lymphoma received methotrexate-based chemoimmunotherapy (R-MPV-A: rituximab, methotrexate, procarbazine, vincristine, cytarabine) with or without low-dose (23.4 Gy in 13 fractions). Complete response rates were high in both arms, but numerically improved from 76% without to 92% with low-dose WBRT. After a median follow-up of 4.6 years, progression-free survival clearly separated in favor of adding low-dose WBRT (HR 0.47), translating to a 2-year progression-free survival of 79% with versus 54% without. Overall survival trended in the same direction but was not statistically different. Importantly, detailed neuropsych testing showed no cognitive penalty from adding 23.4 Gy—if anything, several measures favored the WBRT arm.
TBL: Even in the setting of modern multi-agent systemic therapy, the addition of low-dose whole brain radiation significantly improves disease control without detectable neurocognitive harm. | Omuro, Neuro Oncol 2025
The Study: In a randomized phase II study, 91 patients with newly diagnosed primary CNS lymphoma received methotrexate-based chemoimmunotherapy (R-MPV-A: rituximab, methotrexate, procarbazine, vincristine, cytarabine) with or without low-dose (23.4 Gy in 13 fractions). Complete response rates were high in both arms, but numerically improved from 76% without to 92% with low-dose WBRT. After a median follow-up of 4.6 years, progression-free survival clearly separated in favor of adding low-dose WBRT (HR 0.47), translating to a 2-year progression-free survival of 79% with versus 54% without. Overall survival trended in the same direction but was not statistically different. Importantly, detailed neuropsych testing showed no cognitive penalty from adding 23.4 Gy—if anything, several measures favored the WBRT arm.
TBL: Even in the setting of modern multi-agent systemic therapy, the addition of low-dose whole brain radiation significantly improves disease control without detectable neurocognitive harm. | Omuro, Neuro Oncol 2025