The therapy of primary brain lymphoma

Abstract

Recommendations regarding the current therapy of primary brain lymphoma (NHL-CNS) take into account the occurrence of this tumor in immunocompetent and immunosuppressed hosts. Immunohistochemical evaluation of biopsy material or spinal fluid provides the diagnosis in 90% of patients. For the immunocompetent, pre-irradiation intra-venous or intra-arterial chemotherapy with Methotrexate alone or in combination with other agents is provided to treat tumor within multiple brain sites. Subarachnoid deposits are treated with Methotrexate by intrathecal administration. Radiation is provided after chemotherapy and for the treatment of vitreal/retinal deposits or symptomatic lesions within the spinal axis. The therapy of recurrent NHL-CNS makes use of intravenous Methotrexate or high dose Cytosine Arabinoside. Immunosuppressed patients respond to reduction of immunosuppressive medication. The therapy of NHL-CNS in the AIDS patient makes use of corticosteroids followed by cranial irradiation. A discussion of emerging trends in the therapy of NHL-CNS in the AIDS and non-AIDS population is provided.

Management of Primary Central Nervous System Lymphoma

“…Immunocompetent and immunosuppressed patients with PCNSL display similar clinical symptoms [11]. Nearly half of the patients present with nonfocal symptoms like mental status disturbances, signs of raised intracranial pressure or generalized seizures.…”

“…In none of 60 patients with PCNSL they could verifiy systemic disease. As systemic spreading is found in less than 5% of patients, and relapse outside the CNS occurs only in 10%, Hochberg et al [11] query the need for chest or abdominal CT and bone marrow aspiration. In their mind, essential staging procedures consist of enhanced CT or MRI of the brain, slit-lamp evaluation of the eyes, and a lumbar puncture.…”

“…Predisposing factors for PCNSL are congenital or aquired immundeficiency syndromes, autoimmune diseases, immunosuppressive therapy, and infections [10]. Most of these disorders share T-cell abnormalities [11]. PCNSL accounts for 0.85-2% of all primary brain tumors [12,13], with increasing tendency [1].…”

Valor do exame citológico per-operatório em neurocirurgias

“…ex., criptococose) e definir a conduta, já que a drenagem deve ser a mais ampla possível para facilitar a penetração de agentes antimicrobianos e no tratamento posterior (1,12,30) . Nos casos de linfoma, o tratamento principal não é cirúrgi-co, mas sim a associação de radioterapia e quimioterapia (16) , sendo as ressecções em geral mais restritas, visando apenas à obtenção de material suficiente para diagnóstico adequado, o que muitas vezes requer coloração para reticulina e estudos imuno-histoquímicos. A importância do diagnóstico per-operatório desta neoplasia reside em evitar ressecções desnecessárias e, ao mesmo tempo, avaliar se a amostragem é suficiente para exames posteriores adicionais à rotina de hematoxilina e eosina (HE).…”

Non-Hodgkin's Lymphomas (NHL)

“…Opinions diverge on whether the entire craniospinal canal should be irradiated, several groups recommend it if CSF analysis reveals lymphoma cells (84,85), while others suggest that it leads to complications in later chemotherapy (81). Orbital involvement has been reported in up t o 25% of cases during the course of the disease (82), and therefore the posterior orbit should be included in the target volume (84,86).…”