Chemotherapy is effective as early treatment for primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is a lymphoma arising withi n the brain or spinal cord in the absence of evident localisation outside t he central nervous system (CNS). Poor results in the management of relapsed PCNSL justify the need for Vigorous initial therapeutic regimens, and chem otherapy should not be reserved for recurrent disease. Chemotherapy (M-BACO D scheme) was delivered prior to irradiation in a group of 20 PCNSL patient s, another 8 PCNSL patients underwent radiotherapy only, and the overall su rvival was evaluated. Computed tomography (CT) images in the group of patie nts treated with chemotherapy, showed there to be 70% complete responders ( CR), 15% non-responders (NR) and 15% partial responders (PR). Half of the C R were scheduled for radiotherapy only at tumour recurrence. The median dis ease-free period and survival time of the whole group treated with early ch emotherapy followed by radiotherapy were 24 and 32 months, respectively, bu t in the subgroup of CR (70%), taking into account also the patients not ye t receiving radiotherapy, these were 38 and 48 months, respectively. The di sease-free and survival times in the group of CR (75%) of patients treated with radiotherapy only were 13 and 18 months, respectively. At tumour recur rence, CR to chemotherapy had a second disease-free period longer than 2 ye ars after radiotherapy. Our data support the belief that in scheduling the treatment of PCNSL after histological diagnosis, the first step is to devis e high-dose chemotherapy with drugs able to cross an intact blood-brain bar rier. The results of our primary approach with early chemotherapy in PCNSL support a consensus to continue chemotherapy until tumour recurrence, and o nly at that event to initiate radiotherapy. It is a challenge and an option worthy of continuing investigation.