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- Primary central nervous system (CNS) lymphoma is a malignant tumor derived from white blood cells localized to the brain.
- The possibility of lymphoma originating elsewhere in the body must first be excluded before declaring that the lymphoma is primarily in the CNS.
- These tumors are rare. However, the incidence of these tumors is rising relative to other brain lesions. This is in part due to the occurrence of primary lymphoma in AIDS and transplant patients.
- Most common locations are the frontal lobes and regions around the ventricles of the brain.
- Conditions with increased risk of primary CNS lymphomas:
- Collagen vascular disease, including systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis.
- Immunosuppression, including chronic immunosuppression in transplant patients, severe congenital immunodeficiency syndrome, AIDS.
- Epstein-Barr virus infection.
- The management of CNS lymphoma requires a multidisciplinary team approach, with input from the oncologist, radiation oncologist and neurosurgeon.
- Computed tomography (CT) or magnetic resonance imaging (MRI) scans are used to identify the tumors within the brain.
- A search for the primary site outside the brain is usually undertaken. This may include chest x-ray, CT scan of the chest and abdomen, bone marrow biopsy, testicular ultrasound and eye exam.
- Surgical decompression with partial or total removal does not alter the patient's prognosis. The main role of surgery is tumor biopsy.
- Stereotactic techniques are often well suited for these frequently deep tumors.
- Steroid therapy
- Lymphomas are steroid sensitive. Within hours the brain lesions may be reduced or may disappear as tumor cells are killed.
- The benefits of steroids tend to disappear within six months of treatment.
- Radiation therapy
- Lymphomas respond to external radiation quickly and effectively in 80 percent of patients, but recurrence within the radiation field is the rule.
- The optimal volume to be irradiated depends on the nature of the tumor and the tolerance of the critical normal tissue.
- Because of the generally poor long-term results with radiation only and the high rate of local failure, considerable attention has been focused recently on the role of systemic chemotherapy. Several reports have suggested improved survival when chemotherapy is added to radiation.
The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide