Developments in the diagnosis and treatment of primary CNS lymphoma: A prospective series

Abstract

Current experience with 12 patients studied prospectively suggests a new approach in the diagnosis and treatment of primary central nervous system (CNS) lymphoma, integrating the techniques of needle brain biopsy, immunohistochemical staining for monoclonal antibody and chemotherapeutic drug delivery in association with blood-brain barrier modification. Computed tomography (CT)-guided needle biopsy of deep parenchymal lesions contributed to the diagnosis in six patients. Immunohistochemical staining methods detected monoclonal immunoglobulins in those patients so tested. Following diagnosis, the patients have been treated with multi-agent chemotherapy in conjunction with osmotic blood-brain barrier modification (five without antecedent cranial irradiation) with an initial complete response rate by CT scan in nine patients, a median follow-up of 19 months from diagnosis, and a 1-year survival of 75%. This experience emphasizes the value of CT-guided stereotaxic or CT-guided needle biopsy, which limits the need for therapy without a diagnosis or the need for a major craniotomy in what are commonly deep, paraventricular lesions. Immunoperoxidase cytochemical stains can detect monoclonal immunoglobulin characteristic of CNS B-cell malignant lymphomas and provide an important diagnostic aid when only modest quantities of tissue or cells are obtained. Finally, chemotherapy administered in conjunction with osmotic blood-brain barrier modification results in a clinical response rate and survival that are at least as effective as radiotherapy as a primary therapeutic modality.

Magnetic resonance monitoring of focused ultrasound/magnetic nanoparticle targeting delivery of therapeutic agents to the brain

“…Primary brain tumors or metastases to the brain from breast or lung cancers have markedly different vascular and hemodynamic characteristics than the intact brain (24)(25)(26)(27). Vascular characteristics in tumors vary widely, and permeability does not necessarily correlate with tumor histology, size, or anatomical location.…”

Primary Malignant Lymphoma of the Brain: A report of 24 cases from the Norwegian Radium Hospital

“…Combination chemotherapy following surgery and radiotherapy seems to improve the survival rate (28,29).…”

Enhanced therapeutic agent delivery through magnetic resonance imaging–monitored focused ultrasound blood-brain barrier disruption for brain tumor treatment: an overview of the current preclinical status

“…[29][30][31] This BBB disruptive effect is temporary and reversible and does not damage neural cells. Compared with alternative approaches such as modified lipophilic chemicals or hypertonic solution infused through carotid arteries for enhancing chemotherapeutic agent delivery into the brain, 44 the advantages of MR imaging-guided or MR imagingmonitored FUS-mediated delivery of chemotherapeutic agents include its entirely noninvasive procedure, local BBB disruption that minimizes off-target effects, and reversible BBB disruption within several hours (representing a suitable time window for drug release; Fig. 1).…”