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See review article and MRI scans:
here,
here,
here,
here,
here,
here,
here
untreated these lesions can grow rapidly in the brain (see picture
here)
Primary central nervous system (CNS) lymphoma is defined as lymphoma limited to the
cranial-spinal axis without systemic disease. An increasing incidence of this disease has
been seen among patients with acquired immunodeficiency syndrome (AIDS) and among other
immunocompromised persons. The natural history of this disorder differs between patients
with AIDS and those without AIDS. Computed tomographic (CT) scans may show ring
enhancement in one half of the AIDS patients while patients without AIDS almost always
show only homogeneous enhancement. Both groups do equally poorly without therapy (1-3
month mean survival), but the overall survival for treated patients is much better for
patients without AIDS (18.9 months) than for those with AIDS (2.6 months).
In non-AIDS patients we generally treat with chemotherapy first followed by radiation
see the NCCN guidelines and
NCCN discussion (as noted below the risk of
brain complications, e.g. dementia can be high and the use and proper dose or timing of
radiation is under investigation see Fine , recent consensus statements , RTOG trial and new RTOG Trial . There are
more trials using doses as low as 23Gy (go
here). In the RTOG 0227 trial it
starts with chemoRx (MTX, Rituximab, TMZ) then XRT (whole brain 120cGy bid
to 36Gy) then more TMZ
For more information on treatment go
here and
here |