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Whole brain radiation therapy for CNS lymphoma

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Hui-Kuo G. Shu, MD, PhD
Last Modified: September 29, 2002

Dear OncoLink "Ask The Experts,"

My mother has Primary Central Nervous System (CNS) Lymphoma. After 6 IV methotrexate treatments, her doctor has recommended radiation. What type of radiation procedures do you provide? I assume whole-brain radiation is no longer used?

Hui-Kuo G. Shu, MD, PhD, Assistant Professor in the Department of Radiation Oncology at the University of Pennsylvania, responds:

In fact, whole brain radiation therapy is what is used in cases of CNS lymphoma that has failed IV methotrexate. Quite often, multiple lesions or leptomeningeal spread are seen on imaging studies. Even if only one lesion is seen, the entire brain is at significant risk for recurrence especially in the setting where the lymphoma is apparently failing to respond to the chemotherapy. Overall, whole brain radiation therapy is well tolerated acutely but may have late neurocognitive side effects including a decrease in short term memory and some level of alteration in thinking ability. It is important to remember that neurocognitive side effects will certainly occur eventually in the setting of uncontrolled CNS lymphoma and will most likely be considerably worse than that from the radiation therapy. As always, I recommend that you consult with your physician further regarding potential toxicities of the treatment.