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What whole brain radiation dose would you recommend for primary CNS lymphoma with partial response to HD-MTX-R and R-ICE and planned for concurrent ibrutinib?
Could one de-escalate WBRT dose to <30-36 Gy if maintaining boost to residual disease to 45 Gy? How would you counsel patients on late toxicities following whole brain RT with the addition of ibrutinib?
Answer from: Radiation Oncologist at Academic Institution
There are many uncertainties in how to optimal treat patients with PCNSL. It is clear that high-dose MTX-based regimens should be pursued when feasible. The role, if any, of RT is controversial. If pursued, a WBRT-based approach is generally considered most appropriate.With that said, if a patient o...
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Answer from: Radiation Oncologist at Community Practice
I principally agree with the comments by Prof. @Kelsey. Just some extra thoughts:
A patient with partial response to HD-MTX-R is very unlikely to achieve durable control of the disease, if no high-dose chemotherapy with ASCT or some novel approach (CAR-T) is planned/possible.
On occasion, I ...