Lymphomas primarily occur in the CNS or involve the CNS as part of a generalized disease.
Radiation treatment of intracerebral, intraspinal, or meningeal/cerebrospinal fluid lymphoma manifestations may be appropriate as one or more treatment alternatives. This treatment is often part of a multimodal approach in combination with systemic and intrathecal/intraventricular chemotherapy.
Radiation treatment can be given to the entire CNS axis (brain, spinal cord, and cerebrospinal fluid space down to the S1/2 level, sometimes including both eyes and optical nerves) or only the brain with surrounding fluid space. Due to the diffuse growth and tendency for meningeal involvement of lymphomas, whole brain radiation is almost always indicated. Radiation of only parts of the brain or a boost to parts of the brain is normally not recommended.
Treatment is administered together or at the end of CNS-directed chemotherapy/intrathecal chemotherapy.
In some patients with lymphoma in the CNS, radiation to the entire neuro axis is also used.
Curative radiation therapy
Radiation treatment of of the entire CNS axis can be administered as a segment of curative treatment for:
- Treatment/prophylaxis of CNS manifestations of lymphoblastic/acute lymphoblastic leukemia and Burkitt's lymphoma
- Treatment/prophylaxis of CNS manifestations for acute lymphoblastic leukemia and Burkitt's lymphoma. For treatment/prophylaxis of a CNS disease as part of treatment to cure acute lymphoblastic leukemia, radiation treatment may be included. It is often combined with CNS-directed chemotherapy/intrathecal treatment. It may be appropriate (but not obligatory) to give radiation to the spinal cord simultaneously.
- Treatment/prophylaxis of CNS manifestation from other malignant lymphomas - In other malignant lymphomas where the CNS is involved, radiation treatment to the brain is considered individually as part of a treatment plan to cure the disease. In the case of meningeal spreading or findings in the spinal cord, it may be appropriate to combine with radiation treatment of the spinal cord.
Palliative radiation therapy
- Radiation of the total CNS axis is resource-consuming treatment with side effects. This treatment form is therefore not suited for palliative treatment in all patients with generalized lymphoma in the CNS. For palliative radiation treatment, the method for the radiation therapy itself follows the same guidelines as for curative treatment with individual modifications.