Primary CNS Lymphoma is treated with a combination of different treatments – chemotherapy, steroids and radiation. Treatment is different from other forms of lymphoma because the brain responds differently to treatments than other parts of the body.
Steroids are simple drugs that can be given as pills or as injections. Primary CNS lymphoma responds very well to steroids. So well, in fact, that in some patients the disease may disappear completely. In most patients, however, this good response is only temporary. Steroids are very useful for immediate symptom control. For a more long lasting effect, doctors use chemotherapy or radiation.
No. Surgery is used only to take a biopsy, so that the disease can be diagnosed. It plays no role in the treatment of CNS lymphoma. No matter how much tumor is removed by surgery, there is always some tumor left that cannot be seen. As most CNS lymphomas are situated deep within the brain, it is also difficult for neurosurgeons to take out the tumor without causing damage to the patients’ normal brain.
Until a few decades back, radiotherapy was the only effective treatment for primary CNS lymphoma. Lymphoma in the brain responds fast to radiation. Radiation is given to the whole brain, for 3 to 5 weeks. Most patients have an excellent initial response – the tumors shrink or disappear completely. Symptoms are also well controlled. However, during long-term follow-up, many patients have a recurrence of the tumor. This happens after some months of treatment. Radiotherapy remains a very important part of treatment, but in current treatment practice, it is not used alone, but after chemotherapy.
Chemotherapy plays a very important role in treatment. High doses of a drug called methotrexate are used, often along with one or two more chemotherapy drugs. Chemotherapy is given before radiation to the brain. The total duration of chemotherapy is 3-6 months. As high doses of chemotherapy drugs are needed, there are often several precautions to follow, and the patient may need admission during chemotherapy administration.
The treatment of primary CNS lymphoma in those with AIDS differs from treatment in others. Chemotherapy is used less often, because it may become too toxic for the already sick patients to tolerate. Steroids must also be used with more caution as it may worsen immune system function.
Primary CNS lymphoma is not an easy disease to treat. Without treatment, a person survives for only 2-3 months. Before the discovery of effective chemotherapy schedules, patients often survived for a couple of years with radiation alone. Things have looked up since the development of more effective chemotherapy that can reach the brain. Patients who can tolerate the intensive treatment now often survive for 3 years or more. Some may even have a long lasting cure.
