Whole brain radiation therapy for primary central nervous system marginal zone lymphoma: a case report
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CASE REPORT
Whole brain radiation therapy for primary central nervous system marginal zone lymphoma: a case report Genki Edward Sato1 · Itaru Ikeda1 · Marie Sakoda1 · Kiyotomo Matsugi1 · Takahiko Utsumi2 · Yoko Iwasa3 · Chikako Yamauchi1 Received: 25 June 2020 / Accepted: 23 August 2020 © The Japan Society of Clinical Oncology 2020
Abstract A standard radiation therapy protocol for primary central nervous system marginal zone lymphoma (CNS-MZL) has not been established. The International Lymphoma Radiation Oncology Group suggested a radiation therapy dose of 30–36 Gy for lesions of well-defined CNS-MZL. We report a case of relatively low-dose whole brain radiation therapy (WBRT) for ill-defined CNS-MZL. A 56-year-old man who presented with sudden left-sided convulsions and impaired consciousness was diagnosed with CNS-MZL. The tumor had an ill-defined lesion, without cerebrospinal fluid involvement. WBRT, consisting of 25.2 Gy in 14 fractions, was administered owing to the difficulty in target delineation for focal radiation therapy. No chemotherapy was administered during the treatment course. After the 36-month follow-up period, the patient maintained complete remission without neurological disorders. This report describes the usefulness of relatively low-dose WBRT for ill-defined CNS-MZL. Keywords CNS lymphoma · Marginal zone lymphoma · MALT lymphoma · Dural lymphoma · Whole brain radiation therapy
Introduction Primary central nervous system marginal zone lymphoma (CNS-MZL) is a rare lymphoma. The most common location of CNS-MZL is the dura, accounting for 69–80% of cases [1, 2]. Although the standard therapy for CNS-MZL has not been established by prospective trials, favorable outcomes with local therapies, including radiation therapy, have been reported retrospectively [1, 3, 4]. The International Lymphoma Radiation Oncology Group (ILROG) suggested the following guideline regarding the radiation dose and field for a single and well-defined dural lymphoma (DL): 30–36 Gy for the primary lesion as focal therapy [5]. However, a report * Chikako Yamauchi [email protected]‑u.ac.jp 1
Department of Radiation Oncology, Shiga General Hospital, 5‑4‑30 Moriyama, Moriyama, Shiga 524‑8524, Japan
2
Department of Haematology and Oncology, Shiga General Hospital, 5‑4‑30 Moriyama, Moriyama, Shiga 524‑8524, Japan
3
Department of Pathology, Shiga General Hospital, 5‑4‑30 Moriyama, Moriyama, Shiga 524‑8524, Japan
suggested that a radiation dose lower than 30 Gy may be sufficient to control the primary lesion [3]. To reduce toxicity, lower dose radiation therapy should be considered, if clinical outcomes do not worsen. However, evidence supporting the utility of low-dose radiation therapy has not been established. Additionally, the optimal radiation field for ill-defined lesions is unknown. We report a case whereby relatively low-dose whole brain radiation therapy (WBRT), consisting of 25.2 Gy in 14 fractions, was administered for ill-defined primary CNS-MZL.
Case report A 56-year-old man who presented with sudd
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