Concurrent temozolomide (TMZ) and radiotherapy is the new standard of care for patients with newly diagnosed glioblastoma. In 51 consecutive patients treated according to this regimen, 7 patients (14%) manifested surgically confirmed early necrosis without evidence of recurrent tumor. This observation suggests that daily TMZ may represent a potent radiosensitizing regimen.

Primary CNS non-Hodgkin lymphoma (PCNSL) has been shown to be increasing in incidence. This appears to be a consequence of the increasing population of those older than 65 years of age in whom PCNSL occurs most often. PCNSL often has a favorable response to treatment and aggressive management may result in extended survival and, in a proportion of patients less than 65 years of age, cure. The majority of neuro-oncologist's advocate utilizing high-dose methotrexate (HD-MTX) as a platform for the chemotherapy treatment of these neoplasms. In this review, the literature regarding HDHMTX as a treatment for PCNSL is summarized as are the pharmacological principles of HD-MTX.

There is no standard of care for elderly patients (age>or=70 years) with newly diagnosed glioblastoma (GBM). In 15 consecutive patients (median age 79 years) treated with temozolomide (TMZ) (42 days on; 14 days off), median survival was 6 months (range 4-14 months). This pilot study suggests that low dose daily TMZ may represent an alternative and equally effective treatment to more traditionally administered radiotherapy.

A 36-year-old man with acute lymphoblastic leukemia developed recurrence treated with busulfan and fludarabine followed by transplantation.Disease recurred as leukemic meningitis for which an Ommaya reservoir was placed. Following his sixth intraventricular methotrexate treatment, the patient developed acute confusion and a right hemiparesis. Cranial MR (figure) revealed an encephaloclastic cyst as a complication of intraventricular chemotherapy with methotrexate via an Ommaya reservoir.The reservoir was removed and the cyst contents revealed by histopathology an inflammatory admixture of lymphocytes and macrophages. Cyst contents were bacteriologically sterile and the cyst was negative for malignancy. Subsequently, the patient made a complete neurologic recovery.Ommaya reservoirs are frequently used to deliver intraventricular chemotherapy in cancer patients with leptomeningeal metastases. Methotrexate-induced encephaloclastic cyst is an infrequently described complication of intraventricular chemotherapy among other complications such as aseptic (chemical) meningitis and catheter-related infections.2 Etiopathogenesis is presumed to be due to retrograde flow along the catheter tract of the intended intraventricular chemotherapeutic.

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