Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Clinical outcomes and MRI-based neurotoxicity assessment of elderly primary CNS lymphoma.
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Nagashima Hiroaki, Tanaka Kazuhiro, Yamanishi Shunsuke, Ikeuchi Yusuke, Sasayama Takashi
Аннотация
BACKGROUND: The optimal management of primary central nervous system lymphoma (PCNSL) in elderly patients remains challenging, as whole-brain radiotherapy (WBRT) is associated with substantial delayed neurotoxicity.
METHODS: We retrospectively analyzed 65 patients aged ≥ 65 years diagnosed with PCNSL between 2008 and 2024 who received either high-dose methotrexate (HD-MTX) followed by WBRT (n = 29) or R-MPV with or without WBRT (n = 36). Clinical characteristics, cerebrospinal fluid (CSF) biomarkers, treatment outcomes, and MRI-based ventricular volume-used as a surrogate for treatment-related neurotoxicity-were evaluated. White matter changes were additionally assessed using the Fazekas scale.
RESULTS: The median age was 72 years. Median progression-free survival (PFS) and overall survival (OS) for the entire cohort were 32.8 and 38.2 months, respectively. WBRT was independently associated with inferior PFS and OS. Patients treated with R-MPV without WBRT achieved longer PFS (53.2 vs. 27.2 months) and superior OS (not reached vs. 35.9 months) compared with those receiving HD-MTX plus WBRT. MRI analysis demonstrated significantly greater ventricular enlargement in the WBRT group (14.6% vs. 2.9% per year; p < 0.001). Among WBRT-treated patients, elevated CSF IL-10 (>100 pg/mL) correlated with accelerated ventricular enlargement. Progression of white matter changes assessed by the Fazekas scale was also significantly greater in the WBRT group.
CONCLUSIONS: In elderly PCNSL patients, R-MPV without routine WBRT provides effective disease control while being associated with less structural brain change. CSF IL-10 may represent a potential biomarker of susceptibility to treatment-related brain structural alterations.
METHODS: We retrospectively analyzed 65 patients aged ≥ 65 years diagnosed with PCNSL between 2008 and 2024 who received either high-dose methotrexate (HD-MTX) followed by WBRT (n = 29) or R-MPV with or without WBRT (n = 36). Clinical characteristics, cerebrospinal fluid (CSF) biomarkers, treatment outcomes, and MRI-based ventricular volume-used as a surrogate for treatment-related neurotoxicity-were evaluated. White matter changes were additionally assessed using the Fazekas scale.
RESULTS: The median age was 72 years. Median progression-free survival (PFS) and overall survival (OS) for the entire cohort were 32.8 and 38.2 months, respectively. WBRT was independently associated with inferior PFS and OS. Patients treated with R-MPV without WBRT achieved longer PFS (53.2 vs. 27.2 months) and superior OS (not reached vs. 35.9 months) compared with those receiving HD-MTX plus WBRT. MRI analysis demonstrated significantly greater ventricular enlargement in the WBRT group (14.6% vs. 2.9% per year; p < 0.001). Among WBRT-treated patients, elevated CSF IL-10 (>100 pg/mL) correlated with accelerated ventricular enlargement. Progression of white matter changes assessed by the Fazekas scale was also significantly greater in the WBRT group.
CONCLUSIONS: In elderly PCNSL patients, R-MPV without routine WBRT provides effective disease control while being associated with less structural brain change. CSF IL-10 may represent a potential biomarker of susceptibility to treatment-related brain structural alterations.