Primary Central Nervous System Lymphoma
Carcinoma, Non-Small-Cell Lung
Primary central nervous system lymphoma (PCNSL) is an uncommon brain tumor that appears to be rising in incidence in immunocompetent patients. It usually presents as a parenchymal brain tumor that is multiple in about 40% of patients. However, the eyes, the cerebrospinal fluid (CSF) and spinal cord may also be involved. Biopsy usually reveals a diffuse large B cell lymphoma. Treatment includes chemotherapy and occasionally radiotherapy. The single most important agent is high-dose methotrexate, which can penetrate the blood-brain barrier and has substantial activity against the disease. A variety of regimens using either single-agent methotrexate or methotrexate in combination with other drugs, such as Procarbazine, have been reported to be effective. Radiotherapy is active against PCNSL but can cause delayed leukoencephalopathy, particularly in older patients. Increasingly, efforts are being directed toward the development of a regimen using chemotherapy alone, especially for patients over the age of 60. However, programs using high-dose chemotherapy with autologous stem cell rescue are being studied in younger patients as well. © 2006 John Wiley & Sons, Ltd.
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