The efficacy of intraventricular treatment in therapy of primary central nervous system lymphomas

Systemowe leczenie pierwotnych chłoniaków ośrodkowego układu nerwowego (OUN) z zastosowaniem wysokich dawek metotreksatu (MTX) oraz arabinozydu cytozyny (Ara-C) w chwili obecnej uznawane jest za najbardziej efektywny zestaw leków cytostatycznych. Aktualnie badana jest możliwość poprawy efektywności terapii poprzez dodatkowe iniekcje dokomorowe leków cytostatycznych.Therapy of primary central nervous system lymphomas (PCNSL) by systemic high-dose methotrexate (MTX) and cytarabine (Ara-C) is the most effective chemotherapeutic protocol. The efficiacy of intraventricular treatment is actually evaluated

Primary central nervous system lymphoma as a neurosurgical problem

Primary central nervous system lymphoma (PCNSL) comprises around 3–5% of primary central nervous system (CNS) tumours and around 1% of all non-Hodgkin lymphoma (NHL). Diffuse large B-cell lymphoma (DLBCL) is the most common histological type. High effectiveness of chemo- and radiotherapy for PCNSL regrettably does not eliminate significant risks of recurrence for CNS tumours. That results in higher interest in other treatment options, including surgical procedures. PCNSL remains in the scope of interest for many specialists and neurosurgeons seem to play a more important role

Neurosurgury treatment in multiple myeloma patients

Multiple myeloma (MM) is the neoplastic proliferation associated with a variety of neurological manifestations, caused by metabolic abnormalities or bone destruction. Development of a cerebral myeloma tumor is uncommon. Imaging studies include radiographic skeletal surveys, magnetic resonance imaging, computerized tomography. Treatment patients with MM include the systemic and intrathecal chemotherapy, irradiation but in some patients neurosurgery intervention is needed

Intraventricular treatment of secondary central nervous system lymphoma – Case study and literature overview

Secondary nervous system lymphoma (SCNSL) is a rare extranodal form of non-Hodgkin lymphoma (NHL). This applies to a particular form of lymphoma that does not originally derive from the central nervous system (CNS); it can be both an isolated form of relapse or a systemic part of disease progression. Due to poor prognosis and a lack of established algorithms of therapeutic procedures, it is a big challenge for physicians from many specializations. In our study, we present an interesting case of a patient with a relapsed form of SCNSL for whom a unique form of treatment was used – intraventricular administration of rituximab and methotrexate

Central nervous system involvement during clinical course of chronic lymphocytic leukaemia

Central nervous system involvement (CNS) of chronic lymphocytic leukemia (CLL) is a rare complication. Some analyses of autopsy studies suggest that the complication remains subclinical or is under-diagnosed. The symptoms of patients with leukemic CNS involvement are heterogeneous and nonspecific. Due to the low incidence, there are no treatment guidelines for this problem. Intrathecal chemotherapy and cranial irradiation are often performed

Central nervous involvement by chronic lymphocytic leukaemia

Inclusion of the central nervous system (CNS) in the course of chronic lymphocytic leukaemia (CLL) is rare. At the moment no risk factors or proven treatment methods are known. The disease is described both in its early phase and during its acceleration period, thus it has been suggested that there might be independent mechanisms influencing the development of this condition. As there are no unified diagnostic procedure algorithms each patient needs to be assessed individually. CLL can manifest mostly in elderly people, for whom a possibility of development of neurological disorders with their aetiology different from leukaemia, should also be taken into consideration. The thesis presents a group of seven patients with CLL with CNS infiltration. Patients with prolymphocytic leukaemia, Richter's transformation and the original location of leukemic infiltration within the eye socket constitute an especially interesting case

Multiple myeloma patients in Department of Neurosurgery, Medical University of Lublin

Multiple myeloma is the neoplastic proliferation of plasma cells. There is a significant heterogeneity to the clinical presentation. Neurologic complications are quite common. The causes include metabolic derangements, vertebral compression fractures, base of skull and other bony involvement, but direct involvement of the central nervous system is rare. We describe the patients with multiple myeloma treated in Department of Neurosurgery, Medical University of Lublin

Skuteczność skojarzonego i wspomagającego leczenia temozolomidem u chorych z glejakiem wielopostaciowym. Wieloośrodkowe badanie z randomizacją

Background and purpose The common treatment in patients with newly diagnosed glioblastoma multiforme is the ultimately radical surgical removal of the tumour combined with radiotherapy. This study compared safety and efficacy of radiotherapy alone with radiotherapy combined with temozolomide (TMZ) given before, during, and after radiotherapy. Material and methods The patients operated on for glioblastoma multiforme during the first 21 postoperative days were randomly assigned to the group treated with radiotherapy alone (involved-field radiotherapy in 2 Gy fractions daily five times a week up to the total of 60 Gy over 6 weeks of treatment) or to the group treated with radiotherapy and TMZ, initially in the dose of 200 mg/m2 during 5 postoperative days and after 23 days followed by 75 mg/m2 of body surface area daily, 7 days a week (from the first to the last day of radiotherapy). On completion of radiotherapy, five complementary courses of TMZ were introduced (150–200 mg/m2 for 5 days, repeated every 28 days). The primary outcome measure was overall survival. Results Fifty-eight patients from 3 centres were included in the study. The mean age of patients was 55 years and all the patients underwent a surgical procedure of glioblastoma removal. The mean overall survival in the group treated with TMZ was 16.0 months, whereas in the group with radiotherapy alone the overall survival reached 12.5 months. 24-month survival reached 23% in patients treated with TMZ and 6.7% in those who received radiotherapy only. Haematological complications of third or fourth degree were present in 10% of patients treated with radiotherapy and TMZ. Conclusions The introduction of TMZ before, during and after radiotherapy for newly diagnosed glioblastoma multiforme gives clinically and statistically significant improvement of survival with unremarkably increased toxicity of the treatment.Wstęp i cel pracy U chorych z nowo rozpoznanymi glejakami wielopostaciowymi ogólnie przyjętym postępowaniem jest maksymalnie radykalne operacyjne usunięcie guza uzupełnione napromienianiem. W przedstawionym badaniu porównywano radioterapię jako jedyną metodę leczenia z radioterapią skojarzoną z temozolomidem podawanym przed napromienianiem, w jego trakcie i po zakończeniu radioterapii, oceniając bezpieczeństwo i skuteczność obu metod terapeutycznych. Materiał i metody Pacjentów operowanych z powodu glejaka wielopostaciowego w ciągu 21 dni po zabiegu przydzielano losowo do grupy, w której stosowano wyłącznie radioterapię (napromienianie na pola wydzielone we frakcjach po 2 Gy dziennie 5 razy w tygodniu do całkowitej dawki 60 Gy w ciągu 6 tygodni leczenia), lub grupy leczonej napromienianiem i temozolomidem, początkowo w okresie pooperacyjnym 200 mg/m2 przez 5 dni, następnie po 23 dniach dawką 75 mg/m2 powierzchni ciała dziennie przez 7 dni w tygodniu (od pierwszego do ostatniego dnia radioterapii). Po zakończeniu napromieniania prowadzono pięć uzupełniających kursów leczenia temozolomidem (150–200 mg/m2 przez 5 dni powtarzanymi co 28 dni). Główną miarą wyniku leczenia był całkowity czas przeżycia. Wyniki Do badania włączono 58 chorych z 3 ośrodków. Mediana wieku pacjentów wynosiła 55 lat, wszyscy chorzy byli operowani z powodu glejaka wielopostaciowego. Mediana czasu przeżycia w grupie otrzymującej temozolomid wyniosła 16 miesięcy, natomiast wśród otrzymujących radioterapię 12,5 miesiąca. Przeżycie 24-miesięczne osób w grupie skojarzonego leczenia wyniosło 23%, natomiast w ramieniu kontrolnym – 6,7%. Powikłania hematologiczne 3. lub 4. stopnia pojawiły się u 10% otrzymujących radioterapię łącznie z temozolomidem. Wnioski Podawanie temozolomidu przed radioterapią, w jej trakcie i po radioterapii u chorych na nowo rozpoznanego glejaka wielopostaciowego w istotny klinicznie i statystycznie sposób wydłuża przeżycie przy niewielkim zwiększeniu toksyczności leczenia

Skuteczność skojarzonego i wspomagającego leczenia temozolomidem u chorych z glejakiem wielopostaciowym : wieloośrodkowe badanie z randomizacją

Background and purpose: The common treatment in patients with newly diagnosed glioblastoma multiforme is the ultimately radical surgical removal of the tumour combined with radio therapy. This study compared safety and efficacy of radiotherapy alone with radiotherapy combined with temozolomide (TMZ) given before, during, and after radiotherapy. Material and methods: The patients operated on for glioblastoma multiforme during the first 21 postoperative days were randomly assigned to the group treated with radiotherapy alone (involved-field radiotherapy in 2 Gy fractions daily five times a week up to the total of 60 Gy over 6 weeks of treatment) or to the group treated with radiotherapy and TMZ, initially in the dose of 200 mg/m2 during 5 postoperative days and after 23 days followed by 75 mg/m2 of body surface area daily, 7 days a week (from the first to the last day of radiotherapy). On completion of radiotherapy, five complementary courses of TMZ were introduced (150-200 mg/m2 for 5 days, repeated every 28 days). The primary outcome measure was overall survival. Results: Fifty-eight patients from 3 centres were included in the study. The mean age of patients was 55 years and all the patients underwent a surgical procedure of glioblastoma removal. The mean overall survival in the group treated with TMZ was 16.0 months, whereas in the group with radiotherapy alone the overall survival reached 12.5 months. 24-month survival reached 23% in patients treated with TMZ and 6.7% in those who received radiotherapy only. Haematological complications of third or fourth degree were present in 10% of patients treated with radiotherapy and TMZ. Conclusions: The introduction of TMZ before, during and after radiotherapy for newly diagnosed glioblastoma multiforme gives clinically and statistically significant improvement of survival with unremarkably increased toxicity of the treatment