LAUSR

There is limited data supporting role of radiotherapy in secondary trigeminal nerve lymphoma. The author reported a case of 64-year-old Thai male diagnosed as having gastric diffuse large B cell lymphoma with secondary trigeminal nerve lymphoma. He had previously received one cycle of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) followed by five cycles of rituximab plus CHOP (R-CHOP) with intrathecal methotrexate (MTX) and cytarabine (Ara-C). One month after the last cycle of R-CHOP, he developed a headache and numbness on the left side of his face. MRI revealed thickening of left trigeminal nerve. He received one intrathecal injection of MTX and Ara-C followed by systemic chemotherapy. After he received intrathecal chemotherapy, his symptoms disappeared. Secondary trigeminal nerve lymphoma was implied from clinical response and MRI. Two months later, secondary trigeminal nerve lymphoma progressed. Salvage whole brain irradiation 36 Gy and boost dose along left trigeminal nerve to 50 Gy was given. Unfortunately, he developed heart failure and expired during radiotherapy session. Therefore, this report has failed to support the role of radiotherapy in secondary trigeminal nerve lymphoma. In conclusion, radiation therapy may affect patients who do not respond to systemic chemotherapy or those with palliative aim. This summary is extrapolated from secondary central nervous system lymphoma. More evidence to support is still needed.