Time to revisit reduced-dose radiotherapy for PCNSL?

In this issue of Blood Advances, Tringale et al 1 report a single-institutional analysis of patients with treatment-nave primary central nervous system lymphoma (PCNSL), summarizing changing practices in consolidation strategies and clinical outcomes between 1983 and 2020.Of the 559 patients, 385 (69%) received post-induction consolidation therapy, with either whole-brain radiotherapy (24Gy reduced-dose [RD], or >24Gy standard-dose [SD] WBRT) and cytarabine (Ara-C), autologous hematopoietic cell transplantation (AHCT), or non-myeloablative chemotherapy (NMC), typically Ara-C.WBRT use significantly reduced during this period, from 61% in the 1990s to 12% in the 2010s, largely replaced with AHCT or NMC (4% to 32% and 27% to 52% respectively).This temporal change in consolidation practices was seen across all prognostic groups (Memorial Sloan-Kettering Cancer Centre Recursive partitioning analysis [MSKCC RPA] classes 1-3), with a preference for NMC in higher RPA classes more recently.