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PCNSL — SCE Medical Oncology MCQ

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ModerateCNS TumoursPCNSLSCE Medical Oncology

A 60-year-old man is diagnosed with a primary CNS lymphoma (PCNSL). MRI shows a single enhancing lesion in the deep white matter. He is immunocompetent. ECOG PS 1. Stereotactic biopsy confirms diffuse large B-cell lymphoma. What is the standard induction chemotherapy?

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Correct answer: A — High-dose methotrexate-based regimen

Standard R-CHOP is ineffective for PCNSL due to poor CNS penetration of rituximab, doxorubicin and vincristine. High-dose methotrexate (≥3 g/m²) is the backbone of PCNSL treatment, achieving CSF drug levels. Regimens include HD-MTX + HD-cytarabine ± rituximab (MATRix regimen, IELSG32 trial). Consolidation with autologous stem cell transplant or whole-brain radiotherapy follows induction. WBRT alone is inferior to chemotherapy-based approaches and causes delayed neurotoxicity.

Reference: NICE NG99 Brain tumours in adults; ESMO 2024 CNS Tumour Guidelines; IELSG32 Ferreri et al Lancet Haematol 2016