How is PCNSL treated?
The three main methods for treating PCNSL:
1. Chemotherapy: is
the treatment of cancer with a drug or with a combination of drugs into a
standardized treatment regimen.
2, Biological Therapy: is a type biological agent that works with your immune system to help you fight cancer.
3. Radiation Therapy may be used as a primary or adjuvant modality .
4.In recent years Stem Cell or Bone Marrow transplantation may be employed for recurrent occurrences
NOTE: Surgery other than a needle biopsy or Radios (cavern or gamma knife) is generally not used or recommended.
"High Dose" intravenous methotrexate is the standard baseline treatment for Primary Central Nervous system Lymphoma and can often archive remission by itself. It is often a part of a chemo cocktail along with IV Vinchristine and oral procarbazine.
Chemotherapy will often involve the placement of a "Central Line Port". a central line port ia a device that allows easy (and often high volume) access to your circulatory system.. Central Lines come in a variety of configurations from a simple subcutaneous reservoir in the chest to a multi-access device outside the chest
Radiation has been part of CNS Lymphoma treatment for a long time. Early on it was delivered as whole brain radio THERAPY that irradiates the whole brain. This method can be used to reduce tumor mass either before or after chemo therapy; it is often used to treat tumors that have not responded well to chemotherapy.
Whole brain radi0therapy also subjects healthy brain tissue to the same destructive energy they are using to eradicate the tumor! This can lead to significant and damage to healthy brain matter.
Whole brain radiotherapy often has a range of side effects some short term treatable by medicine such as:
Migraine like headaches, nausea and vomiting, and "burnt” skin (similar to extreme sunburn).
Whole brain radiotherapy can produce "late-onset (1 to 5 years after treatment) long-term (sometimes permanent) side effects" such as:
Permanent hair loss, chronic fatigue, hearing loss, poor brain function, and seizures.
For many years now there has been an option of stereotactic radio SURGERY that precisely focuses radiation on the tumor(s) sparing the surrounding brain tissues preventing collateral damage and avoiding many of the side effects! Some of the stereotactic radio SURGERY options available are "Cyber Knife" and "Gamma Knife" These options are still newcomers to the available treatment options are available at a limited number of facilities.
I was given the option of an early form of stereotactic radio surgery or whole brain radio therapy in 2003. I knew Lymphoma was a cancer of the blood and was by nature a rather diffuse cancer. I wanted to destroy any and all possible cancerous cells that might be hiding in the nooks and crannies of my brain! I chose whole brain radiotherapy. I currently have balance issues and Chronic fatigue that effect my general mobility, I've lost a substantial amount of my hearing which has been replace with a permanent high pitched streaking in my ears (tinnitus). I’am dealing with noticeable cognitive issues. Some of this could be the effects of ten years of aggressive treatment but many of these side effects showed up within two years of my WBRT and were resurrected and amplified during my following battles
Nowadays, lasting remission can often be achieved with chemotherapy alone! In severe cases stereotactic radioSUGERY might be beneficial but I personally from my experience see no need for whole brain radioTHERAPY.