• Journal of Korean Neurosurgical Society
• /
• 제39권6호
• /
• pp.409-412
• /
• 2006

Objective : Primary central nervous system lymphoma[PCNSL] is a non-Hodgkin's lymphoma arising in the central nervous system. Combined chemotherapy and radiation therapy is the standard treatment for PCNSL. However, treatment induced neurotoxicity is a major problem especially in elderly patients. Methods : From May 2001 to April 2004, elderly five patients with PCNSL confirmed via pathological examination were underwent Novalis radiosurgery in authors' institution, who were investigated retrospectively. Of these patients, 2 were male and 3 were female, with a mean age 68 years old [range $65{\sim}73$]. The number of lesions was 1 in 2 patients, 2 in 2, and 3 in 1. The mean follow up period was 12.6 months [range $8{\sim}16$]. Results : Clinical symptoms and signs in all patients markedly improved within 1 weeks after Novalis radiosurgery. The Karnofsky performance status score was also improved from a pre-radiosurgery average of 68 to a post-radiosurgery one of 82. All of treated lesions showed a partial or complete regression of the original mass. There have been no complication following Novalis radiosurgery. Conclusion : The preliminary results of our experience indicate that radiosurgery with Novalis provides a safe and effective therapeutic alternative treatment of PCNSL in elderly patients.

• Radiation Oncology Journal
• /
• 제12권1호
• /
• pp.33-42
• /
• 1994

1982년부터 1991년까지 경희대학병원 치료방사선과에서 원발성 중추신경계 림프종으로 확진되어 방사선치료를 받은 16명의 환자를 대상으로 치료결과를 후향적으로 분석하였다. 가장 흔한 세포아형은 large, noncleaved cell과 B cell의 immunoblastic 림프종이었으며 측두엽과 심핵부위에 호발하였다. 치료는 환자를 생검 또는 절제술후 전뇌에 40 Gy(range=30-50 Gy)를 방사선 조사하였으며 원발병소에 15-20 Gy를 추가조사하였다. 16명의 환자중 14명은 방사선치료후 2개월에서 49개월 사이에 사망하였으며, 2명은 재발없이 각각 8개월과 22개월째 생존하고 있다. 1년 및 2년생존율은 각각 55.6$ \% $와 34.7$ \% $이었고, 중간 생존기간은 12개월이었다. 16명의 환자중 재발된 11명을 분석하였다. 방사선치료후 원발부위에 재발은 드물었으나 전뇌조사에서 불구하고 다른 부위에서 재발하였다. 재발율은 뇌에서 68.7$ \% $ (l1/16)이고 척추에서 25.0$ \% $(4/16)이었다. 나이, 성별 발생부위, 병소수, 방사선치료선량등은 각각 생존율과 무관하였다. 이와 같은 결과로 중추신경계 림프종은 방사선 치료의 초기반응은 양호하나 통상적인 방사선치료만으로는 조절이 어려운 질환이다. 따라서 분할치료방법에 의한 방사선량 증가와 항암제의 병용으로 중추신경계 림프종에 대한 치료효과를 향상시키리라 기대한다.

• Journal of Yeungnam Medical Science
• /
• 제38권3호
• /
• pp.258-263
• /
• 2021

Neurolymphomatosis (NL) is defined as the involvement of the peripheral nervous system in lymphocytic invasion. It is a very rare form of lymphoma that may occur as an initial presentation or recurrence. It affects various peripheral nervous structures and can therefore mimic disc-related nerve root pathology or compressive mononeuropathy. NL often occurs in malignant B-cell non-Hodgkin lymphomas. Notwithstanding its aggressiveness or intractability, NL should be discriminated from other neurologic complications of lymphoma. Herein, we present a case of primary NL as the initial presentation of diffuse large B-cell lymphoma (DLBCL) of the sciatic nerve. The patient presented with weakness and pain in his left leg but had no obvious lesion explaining the neurologic deficit on initial lumbosacral and knee magnetic resonance imaging (MRI). NL of the left sciatic nerve at the greater sciatic foramen was diagnosed based on subsequent hip MRI, electrodiagnostic test, positron emission tomography/computed tomography, and nerve biopsy findings. Leg weakness slightly improved after chemotherapy and radiotherapy. We report a case wherein NL, a rare cause of leg weakness, manifested as the initial presentation of primary DLBCL involving the sciatic nerve at the greater sciatic foramen.

• Journal of Korean Neurosurgical Society
• /
• 제29권12호
• /
• pp.1628-1633
• /
• 2000

Objective : The incidence of primary CNS lymphoma(PCNSL) has been increasing recently. The purpose of this study is to establish of prognostic factors and treatment options for PCNSL. Methods : Thirty-one PCNSL patients were treated in our institute between 1985 and 1997. All patients were histologically confirmed via stereotactic biopsy or open biopsy. The authors retrospectively analyzed clinical characteristics of PCNSL and prognostic factors, including histological cell types, immunohistological cell types and treatment options of PCNSL. Our data were statistically analyzed using Kaplan Meier survival curve and multivariated ANOVA test. Results : The clinical and radiological characteristics of PCNSL were resembled to those of other reports. The most common histological subtype was diffuse large cell type(55.5%). In immunohistolgical study, the incidence of T-cell lymphoma(35.7%) was very higher than that of others. The radiotherapy could prolonged patients' survival(p=0.021). One-year and 3-year survival rate of PCNSL were 66.9% and 45.9%, respectively. One-year survival rate of B cell and T cell lymphoma were 72.7% and 50.0%, respectively. The patients with B-cell lymphoma showed better prognosis than patients with T-cell lymphoma(p=0.049). Conclusion : On the basis of our data, active radiotherapy could prolong patients' survival. the T-cell lymphoma revealed higher incidence than those of other reports and had poor prognosis than that of B cell lymphoma.

• Journal of Korean Neurosurgical Society
• /
• 제30권3호
• /
• pp.334-341
• /
• 2001

Objective : We have currently changed treatment strategies to methotrexate(MTX)-based preirradiation chemotherapy with subsequent planned radiation for the initial therapy of primary central nervous system lymphoma (PCNSL). The aim of this study was to evaluate the results of treating PCNSL with chemotherapy plus radiotherapy (CRT) or radiotherapy(RT) alone. Method and Material : This study involved 10 females and 3 males patients with a mean age of 54.2 years. All patients underwent surgery, open(8 cases) or stereotactic biopsy(5 cases) for histological diagnosis. Eleven tumors were diffuse large B-cell lymphomas. Tumor volume change in the follow-up images and survival time were evaluated in patients treated with CRT and RT alone. In the beginning, two patients received ProMACE-Cytabom chemotherapeutic regimen, but did not complete the course and died of progressive tumor 8 and 9 months after diagnosis, respectively. One patient died at 6 months before chemotherapy. These three were excluded from the survival analysis. Five patients(RT group) completed full courses of cranial irradiation with or without boost. For the current combined modality treatment, high-dose MTXbased chemotherapy(systemic and intrathecal MTX, IV vincristine, and oral procarbazine) followed by whole brain irrdiation to 45Gy to tumor was introduced in 5 patients of CRT group. Result : A complete response was achieved in three of five who received RT only and in all of five who received CRT. All patients in CRT groups are in disease free status at a mean 23 months following therapy. The RT group patients refused any additional salvage therapy at tumor relapse and survived at mean 20 months from diagnosis. The Karnofsky performance status improved in eight of ten patients with treatment. The treatment toxicity included leukoencephalopathy in RT group and severe leukopenia, transient hepatitis, avascular necrosis of femoral head, hearing loss, and amenorrhea in CRT group, respectively. Conclusion : The combined modality therapy of MTX-based chemotherapy plus radiotherapy for PCNSL may enhance tumor response and improve patient survival. The patients who received CRT should be carefully followed up because of the higher risk of treatment-induced late neurotoxicity.

• Investigative Magnetic Resonance Imaging
• /
• 제21권1호
• /
• pp.9-19
• /
• 2017

Background: Normalized cerebral blood volume (nCBV) can be measured using manual or semiautomatic segmentation method. However, the difference in diagnostic performance on brain tumor differentiation between differently measured nCBV has not been evaluated. Purpose: To compare the diagnostic performance of manually obtained nCBV to that of semiautomatically obtained nCBV on glioblastoma (GBM) and primary central nervous system lymphoma (PCNSL) differentiation. Materials and Methods: Histopathologically confirmed forty GBM and eleven PCNSL patients underwent 3T MR imaging with dynamic susceptibility contrast-enhanced perfusion MR imaging before any treatment or biopsy. Based on the contrast-enhanced T1-weighted imaging, the mean nCBV (mCBV) was measured using the manual method (manual mCBV), random regions of interest (ROIs) placement by the observer, or the semiautomatic segmentation method (semiautomatic mCBV). The volume of enhancing portion of the tumor was also measured during semiautomatic segmentation process. T-test, ROC curve analysis, Fisher's exact test and multivariate regression analysis were performed to compare the value and evaluate the diagnostic performance of each parameter. Results: GBM showed a higher enhancing volume (P = 0.0307), a higher manual mCBV (P = 0.018) and a higher semiautomatic mCBV (P = 0.0111) than that of the PCNSL. Semiautomatic mCBV had the highest value (0.815) for the area under the curve (AUC), however, the AUCs of the three parameters were not significantly different from each other. The semiautomatic mCBV was the best independent predictor for the GBM and PCNSL differential diagnosis according to the stepwise multiple regression analysis. Conclusion: We found that the semiautomatic mCBV could be a better predictor than the manual mCBV for the GBM and PCNSL differentiation. We believe that the semiautomatic segmentation method can contribute to the advancement of perfusion based brain tumor evaluation.

• Radiation Oncology Journal
• /
• 제38권1호
• /
• pp.35-43
• /
• 2020

Purpose: This retrospective study compares higher-dose whole-brain radiotherapy (hdWBRT) with reduced-dose WBRT (rdWBRT) in terms of clinical efficacy and toxicity profile in patients treated for primary central nervous system lymphoma (PCNSL). Materials and Methods: Radiotherapy followed by high-dose methotrexate (HD-MTX)-based chemotherapy was administered to immunocompetent patients with histologically confirmed PCNSL between 2000 and 2016. Response to chemotherapy was taken into account when prescribing the radiation dose to the whole brain and primary tumor bed. The whole brain dose was ≤23.4 Gy for rdWBRT (n = 20) and >23.4 Gy for hdWBRT (n = 68). Patients manifesting cognitive disturbance, memory impairment and dysarthria were considered to have neurotoxicity. A median follow-up was 3.62 years. Results: The 3-year overall survival (OS) and progression-free survival (PFS) were 70.0% and 48.9% with rdWBRT, and 63.2% and 43.2% with hdWBRT. The 3-year OS and PFS among patients with partial response (n = 45) after chemotherapy were 77.8% and 53.3% with rdWBRT, and 58.3% and 45.8% with hdWBRT (p > 0.05). Among patients with complete response achieved during follow-up, the 3-year freedom from neurotoxicity (FFNT) rate was 94.1% with rdWBRT and 62.4% with hdWBRT. Among patients aged ≥60 years, the 3-year FFNT rate was 87.5% with rdWBRT and 39.1% with hdWBRT (p = 0.49). Neurotoxicity was not observed after rdWBRT in patients aged below 60 years. Conclusion: rdWBRT with tumor bed boost combined with upfront HD-MTX is less neurotoxic and results in effective survival as higher-dose radiotherapy even in partial response after chemotherapy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제36권6호
• /
• pp.497-501
• /
• 2010

Primary nasal type natural killer (NK)/T cell (NKTC) lymphoma, a specific form of malignant lymphoma, has a higher geographic incidence in Oriental, Mexican, and South American populations than the Western population. In Koreans, it comprises 9-12% of all cases of non-Hodgkin's lymphoma. This type of lymphoma has also been named as angiocentic lymphoma and lethal midline granuloma because the most common site is the upper airway area and its clinical aggressiveness presents with a necrotic and destructive pattern. NKTC lymphoma can also be detected in different organs (testis, spleen, parotid gland, skin, gastroinstinal tract, central nervous system, lungs, bone marrow, etc.) other than the upper airway including the oral cavity. The lymphoma detected in the oral cavity shows various destructive and inflammatory changes, similar to the signs of inflammation and infection from periodontitis and pulpal disease, making a diagnosis difficult with just the clinical signs. For early detection, clinical, radiological, and pathological examinations are required. This report describes the clinical, radiological and histological characteristics with a case report for the early detection of NKTC lymphoma in the oral cavity.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권11호
• /
• pp.4733-4738
• /
• 2014

Purpose: We developed and evaluated a regimen including fotemustine, teniposide and dexamethasone (FTD) for treating patients with central nervous system (CNS) lymphoma based on pharmacokinetic properties of individual agents and in combination. Patients and Methods: In a comparison study, 8 patients with primary CNS lymphoma (PCNSL) and 8 with secondary CNS lymphoma (SCNSL) were treated with FTD (comprising fotemustine 100 mg/m2, 1h infusion, day 1; teniposide 60 mg/m2, >0.5 h infusion, on day 2, 3, 4; dexamethasone 40 mg, 1h infusion, on day 1, 2, 3, 4 and 5; and methotrexate 12 mg, cytosine arabinoside 50 mg plus dexamethasone 5 mg intrathecally, on day 2 and 7). Cycles were repeated every 3 weeks. After response assessment, patients received whole brain radiotherapy. Results: Of the 8 PCNSL patients, 4 (50%) achieved CR and 3 (38%) PR, an overall response rate of 88%. Four patients (50%) were in continuing remission at the end of this study after a median follow-up of 30 months (range 10 to 56 months). Of the 8 SCNSL patients the overall response rate was 63% (CR+PR: 38%+25%). All responses were achievable with predictable toxicity mainly reflecting reversible myelosuppression. Conclusion: This study suggests that FTD could be an effective treatment for CNS lymphoma, and is worthy of further evaluation.

• 대한영상의학회지
• /
• 제82권6호
• /
• pp.1613-1618
• /
• 2021

중추신경계의 원발성 림프종은 비호지킨림프종의 드문 형태이다. 그중에서도 말총의 원발성 T세포 림프종은 극히 드물다. 이 증례 보고는 4개월 전부터 시작된 허리통증과 하지방사통을 주소로 내원한 56세 여성의 증례에 대한 것이다. 요추 MRI에서 10 cm 크기의 길다란 다결절의 경막 내 병변이 4번 요추에서부터 2번 미추까지 있었으며 T1 강조영상에서는 등신호강도이고 T2 강조영상에서는 비균질적인 등신호강도와 고신호강도, 가돌리늄 조영증강 T1 강조영상에서는 비균질적인 강한 조영증강을 보였다. 말총 종괴에 대한 수술적 경막 내 생검을 시행하였고 면역조직화학염색과 T-cell receptor gamma 유전자 재배열 분석을 통한 진단은 말총의 말초 T세포 림프종이었다.