What is the role of corticosteroids in the treatment of primary central nervous system lymphoma (PCNSL)?

Updated: Jan 19, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Corticosteroids are avoided during the initial workup, because their administration may have a direct antitumor effect on B-cell lymphoma (B lymphocytes have glucocorticoid receptors on their surfaces) and cause dramatic reduction in MRI abnormalities, making biopsy and histologic confirmation more difficult.

Similarly, corticosteroids should be avoided, if possible, during chemotherapy, because repair of the blood-brain barrier may decrease the delivery of methotrexate into the brain parenchyma. However, the use of corticosteroids may improve quality of life by minimizing symptoms due to vasogenic edema or tumor mass effect; the smallest effective dose should be prescribed.


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