CNS+Lymphoma

Headaches Cataracts Seizures Memory deficiency Thinking and speech problems Difficulty with learning, reading and writing Loss of balance and/or trouble walking Otitis externa Serous otitis media Dermatitis Hormone dysfunction High tone hearing loss Vestibular damage Nausea and vomiting Fatigue Secondary tumor Leukoencephalopathy Opportunistic infections Death[2] || Tumors typically recur within several months of treatment, with the median survival of roughly a year.[2,5] || Whole brain irradiation including the posterior orbits to doses 40-50 Gy with or without a boost to primary tumor to 60-65 Gy is recommended for non-immunosuppressed patients. If there is ocular involvement, the entire eye should be included in the whole brain field. After 30-40 Gy, the lacrimal apparatus and anterior chamber should be shielded. Craniospinal irradiation is recommended for patients with proven CSF involvement. Chemotherapy treatment with high-dose methotrexate with leucovorin and intraarterial mannitol (to open blood brain barrier) has shown prolonged remission. [5] Combined chemotherapy/whole brain radiation therapy has given good results. Chemo agents studied include cyclophosphamide, doxorubicin, vincristine, prednisone,dexamethasone, methotrexate, or cytarabine. Chemo is delivered intrathecally and intravenously. [2] || Brain 45 Gy 50 Gy 60 Gy Brainstem 50 Gy 53 Gy 60 Gy  Cauda equina 60 Gy  Ear 55 Gy 55 Gy 55 Gy  Lens 10 Gy  Optic chiasm 50 Gy  Optic nerve 50 Gy  Retina 45 Gy  Spinal cord 47 Gy(20 cm) 50 Gy(10 cm) 50(5 cm) [2] || [2] Chao C, Perez C, Brandy L. //Radiation Oncology Management Decisions.// 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. [3] Batchelor T. //Lymphoma and Leukemia of the Nervous System//. 2nd ed. New York, NY: Springer; 2012. [4] Newton HB. //Handbook of Brain Tumor Chemotherapy//. San Diego, CA:Academic Press; 2006. [5] Lenhard RE, Osteen RT, Gansler T. //The American Cancer Society's Clinical Oncology//. Atlanta, GA: The American Cancer Society; 2001. [6] http://ars.els-cdn.com/content/image/1-s2.0-S0360301603022417-gr1.jpg Accessed May, 30,2012.
 * **Epidemiolgy:** || A primary central nervous system lymphoma (PCNSL) is also known as microglioma and primary brain lymphoma. It occurs one in every one hundred thousand people. The most common age of diagnosis is between fifty two and fifty five years old. People with immune deficiency conditions, such as transplant or AIDS, have a higher risk of PCNSL. Patients with AIDS have risk of two to six percent of getting PCNSL.[1] ||
 * **Etiology:** || The main cause of central nervous system lymphoma is unknown. It is known to be common among individuals with suppressed immune systems. Individuals with diseases that are linked with X chromosomes seem to have a higher risk of developing PCNSL. [1] ||
 * **Signs & Symptoms:** || The symptoms of PCNSL include headache, nausea and vomiting, seizures, changes in personality, weakness, and difficulty swallowing.[2] ||
 * **Diagnostic Procedures:** || * A complete history and general physical examination
 * Biopsy
 * Neurological examination.
 * Brain and spine MRI.
 * Complete blood counts.
 * Diagnosis can be confirmed by immunohistochemical positivity for leukocyte common antigen and specific B cell markers.
 * Pediatric CNS lymphoma can show on neuroimaging as a solitary mass or as a multifocal tumor in the parietal and frontal lobes.[3] On contrast enhanced CT, a heterogeneous ring like pattern can be seen.
 * Ophthalmologic evaluation should also be included. ||
 * **Histology:** || Most tumors are intermediate or high grade lymphomas and are highly proliferative tumors. They display a perivascular cellular orientation, with expansion of vessel walls and reticulin deposition.[4] ||
 * **Lymph node drainage:** || CNS Lymphoma develops in the lymphatic system, which can spread to lymph nodes throughout the body. ||
 * **Metastatic spread:** || Typically, CNS lymphoma does not metastasize from the central nervous system or the eye. [2] ||
 * **Grading:** || Primary Central Nervous System Lymphoma (PCNSL) is now known to be a form of extranodal, high-grade non-HodgkinB-cell neoplasm, usually large cell or immunoblastic type. [2] ||
 * **Staging:** || It originates in the brain, leptomeninges, spinal cord, or eyes; typically remains confined to the CNS; and rarely spreads outside the nervous system. Therefore, it can be classified as stage 2 disease. [2] ||
 * **Radiation side effects:** || Alopecia
 * **Prognosis:** || Prognostic factors include age, tumor type, tumor grade, seizure symptoms, duration of symptoms, performance status, extent of resection, radiation doses.[2] Patients who are diagnoses after the age of 60 have a worse prognosis and are more likely to suffer from severe neurotoxicity if survival is more than a year.
 * **Treatments:** || Corticosteroids can be used to improve symptoms temporarily.
 * **TD 5/5:** || __ ORGAN WHOLE ⅔ ⅓ __
 * **References:** || [1] Hansen KE, Roach M. //Handbook of Evidence-Based Radiation Oncology//. 2nd ed. New York, NY: Springer; 2010.



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