Primary central nervous system lymphoma
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Primary central nervous system lymphoma Microchapters |
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Differentiating Primary Central Nervous System Lymphoma from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Classification
History & Symptoms
Diagnosis
MRI
CT
Other Diagnostic Studies
Because imaging techniques cannot distinguish the two conditions with certainty, patients usually undergo brain biopsy if the lesion is solitary or a trial of toxoplasmosis therapy is non-therapeutic. In the future, it may be possible to use PCR assay of cerebrospinal fluid for EBV DNA.
Treatment
Medical Therapy
Surgical resection is usually ineffective because of the depth of the tumor. Treatment with irradiation and corticosteroids often only produces a partial response, but tumor recurs in more than 90% of patients. Median survival is 10 to 18 months in immunocompetent patients, and less in those with AIDS. The addition of IV methotrexate and citrovorum may extend survival to a median of 3.5 years. If radiation is added to methotrexate, median survival may increase beyond 4 years. However, radiation is not recommended in conjunction with methotrexate because of increased risk of leukoencephalopathy and dementia in patients older than 60 years of age[1].
References
- ↑ Deangelis LM, Hormigo A. Treatment of primary central nervous system lymphoma. Semin Oncol 2004; 31:684-692. In AIDS patients, perhaps the most important factor with respect to treatment is the use of highly active anti-retroviral therapy (HAART), which affects the CD4+ lymphocyte population and the level of immunosuppression