A randomized trial is reported comparing MTX alone to MTX with WBRT for responders with primary CNS lymphoma. Designed as a non-inferiority trial for progression-free survival, it failed to meet it's endpoint, however, it is observed that the toxicity associated with WBRT in not insignificant. This mirrors the approach taken at Duke currently, of the selective use of WBRT after MTX, with care taken to limit exposure to those at highest risk of toxicity (particularly those >60 years of age). Of course in the non-responders, the worst toxicity is going to be progressive disease without further treatment.
[Articles] High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial: "No significant difference in overall survival was recorded when whole brain radiotherapy was omitted from first-line chemotherapy in patients with newly diagnosed primary CNS lymphoma, but our primary hypothesis was not proven. The progression-free survival benefit afforded by whole brain radiotherapy has to be weighed against the increased risk of neurotoxicity in long-term survivors."