Cranial Computed Tomography in the Tumorous Stage of Mycosis Fungoides

Mycosis Fungoides with CNS Involvement: Neuropsychiatry Manifestations and Complications of Treatment with Intrathecal Methotrexate and Whole‐Brain Irradiation

“…Laboratory evaluation including bone marrow biopsy is usually unremarkable, in contrast to the findings in non‐Hodgkin's lymphoma of the CNS. Computerized tomography scan of the brain may be consistent with lymphoma, but is often nonspecific, showing one to several variable‐sized nodules or masses in the presence of edema 15 . The differential diagnosis includes non‐MF lymphoma, leukemia, plasmacytoma, Hodgkin's disease, melanoma, histiocytosis X, Behcet's disease, and reticulum cell sarcoma.…”

Temozolomide for central nervous system involvement in mycosis fungoides

“…However, this strategy is associated with rates of neurotoxicity of up to 20%, particularly in elderly patients . The published outcomes for both of these treatments in MF patients are generally poor and include median survival periods of just six months and only three months in those treated with radiation alone . The longest survival reported was 18 months following systemic chemotherapy, intrathecal methotrexate, and radiation with subsequent repeated dosing of methotrexate through an Ommaya reservoir …”

“…A literature search revealed 30 published MF patients treated with chemotherapy and/or radiation for CNS involvement (Table 1). 5,7,[11][12][13][14][15][16][17][18][19][20][21][25][26][27][28][29][30][31][32] The most common treatments offered were chemotherapy regimens containing high-dose methotrexate or cytarabine and whole-brain irradiation. This approach is commonly used in patients with primary cerebral lymphoma, with reported response rates of 40-64% and 2-year survival rates of 39-56% in this disease.…”

“…Based on evidence for their use in other types of CNS lymphoma, methotrexate‐based chemotherapy regimens are often used in patients with adequate performance status. The success of this strategy in MF appears limited …”

“…The success of this strategy in MF appears limited. [11][12][13][14][15][16][17][18][19][20][21] Central nervous system irradiation is also used to treat CNS involvement in MF, either as sole therapy or as an adjunct to chemotherapy. Typical doses delivered are reported to range between 20 and 40 Gy.…”