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

E. A. Neuwelt, E. P. Frenkel, M. K. Gumerlock, R. Braziel, B. Dana, S. A. Hill

Research output: Contribution to journalArticle

105 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1609-1620
Number of pages12
JournalCancer
Volume58
Issue number8
StatePublished - 1986

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Lymphoma
Central Nervous System
Needle Biopsy
Blood-Brain Barrier
Tomography
Immunoglobulins
Staining and Labeling
Cranial Irradiation
Therapeutics
Drug Therapy
Craniotomy
B-Cell Lymphoma
Coloring Agents
Radiotherapy
Survival Rate
Monoclonal Antibodies
Survival
Brain
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Neuwelt, E. A., Frenkel, E. P., Gumerlock, M. K., Braziel, R., Dana, B., & Hill, S. A. (1986). Developments in the diagnosis and treatment of primary CNS lymphoma. A prospective series. Cancer, 58(8), 1609-1620.

Developments in the diagnosis and treatment of primary CNS lymphoma. A prospective series. / Neuwelt, E. A.; Frenkel, E. P.; Gumerlock, M. K.; Braziel, R.; Dana, B.; Hill, S. A.

In: Cancer, Vol. 58, No. 8, 1986, p. 1609-1620.

Research output: Contribution to journalArticle

Neuwelt, EA, Frenkel, EP, Gumerlock, MK, Braziel, R, Dana, B & Hill, SA 1986, 'Developments in the diagnosis and treatment of primary CNS lymphoma. A prospective series', Cancer, vol. 58, no. 8, pp. 1609-1620.
Neuwelt EA, Frenkel EP, Gumerlock MK, Braziel R, Dana B, Hill SA. Developments in the diagnosis and treatment of primary CNS lymphoma. A prospective series. Cancer. 1986;58(8):1609-1620.
Neuwelt, E. A. ; Frenkel, E. P. ; Gumerlock, M. K. ; Braziel, R. ; Dana, B. ; Hill, S. A. / Developments in the diagnosis and treatment of primary CNS lymphoma. A prospective series. In: Cancer. 1986 ; Vol. 58, No. 8. pp. 1609-1620.
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