Primary CNS Lymphoma

Spinal Tumors

Primary CNS Lymphoma

Management: 

• Age <60 years: combined modality therapy with Chemotherapy (high dose methotrexate) and RT Whole brain RT 40 Gy + local boost (16 Gy in 8 #)  and CSI (if CSF positive). 

• Age > 70 and/or disabled (KPS <60): RT alone 

• Age 60 to 70:  individualize

Spinal Tumors

Spinal Ependymoma

• Completely excised myxopapillary ependymoma - no further treatment
• High grade ependymoma and incompletely excised low grade ependymoma - local RT (GTV- all hyperintensity on the T2W/FLAIR + 2-3cm margin). 

Dose: 50-54 Gy/30 fractions, depending upon the length of the treatment fields.

Spinal Astrocytomas

Low grade astrocytoma (incompletely and apparently completely excised) as well as high grade astrocytoma --involved field radiotherapy (GTV + 2 cm margin) 

Dose: Short segment of cord -45 Gy/25# followed by boost to 5.4 Gy/3# Long segment of cord- 45Gy in 25# Dose adjustment if cord compressed particularly in association with vascular disease.

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