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PCNSL Treatment — SCE Medical Oncology MCQ

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ModerateCNS TumoursPCNSL TreatmentSCE Medical Oncology

A 60-year-old man develops primary CNS lymphoma (PCNSL). MRI shows an enhancing periventricular lesion. Biopsy confirms DLBCL. What is the standard first-line treatment?

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Correct answer: D — High-dose methotrexate-based regimen (e.g. MATRix: HD-MTX, cytarabine, thiotepa, rituximab) — standard R-CHOP does NOT cross the BBB adequately; HD-MTX achieves therapeutic CNS concentrations

PCNSL treatment requires CNS-penetrating agents. R-CHOP is ineffective (poor BBB penetration of most components). HD-MTX (≥3 g/m²) is the backbone, achieving therapeutic CSF levels. MATRix (IELSG32: HD-MTX + cytarabine + thiotepa + rituximab) is the current standard, followed by consolidation (autologous SCT or WBRT in selected patients). Complete resection is not attempted (diffuse infiltrative tumour).

Reference: NICE NG99; IELSG32; ESMO 2024 CNS