A new schedule of treatment for primary central nervous system lymphoma (PCNSL)

Dismal results in the management of PCNSL justify the need for vigorous initial therapeutic regimens . Chemotherapy should not be reserved for recurrent disease. M BACOD scheme delivered prior to irradiation was efficacious in a group of 20 PCNSL patients. CT images displayed 70% of the complete responses (CR), 15% of no responses (NR), and 15% of partiale responses (PR). Half of the CR patients were scheduled for radiotherapy only at tumor recurrence . The median TTP and ST of the whole group of PCNSL treated with early chemotherapy followed by radiotherapy, were 24 and 32 months respectively , but in the subgroup of CR (70%) taking into account also the patients not yet receiving radiotherapy the TTP and ST was 38 and 48 months respectively. Patients CR to chemotherapy at tumor recurrence had a second disease-free period longer than two years after radiotherapy. Our data support the knowledge that in scheduling the treatment of PCNSL , the first step is devising high-dose chemotherapy with drugs able to cross an intact BBB. Our primary approach with early chemotherapy in PCNSL , corroborate a consensus to continue chemotherapy until tumur recurrence, and only at that time to initiate radiotherapy . It is a challenge and an option worthy of continuing investigation.