Lymphomatous Meningitis in Primary Central Nervous System Lymphoma

Marc C. Chamberlain, M.D.

Disclosures

Neurosurg Focus. 2006;21(5) 

In This Article

Radiotherapy Management

Radiotherapy is used in the treatment of LM for several reasons: 1) palliation of symptoms, such as a cauda equina syndrome, 2) to decrease space-occupying disease such as large-volume subarachnoid metastases, and 3) to correct CSF flow abnormalities demonstrated by radionuclide ventriculography. Patients may exhibit significant symptoms despite the absence of imaging evidence of space-occupying disease and still benefit from radiotherapy. For example, patients with low-back pain and leg weakness should be considered for radiotherapy of the cauda equina, and those with cranial neuropathies should be offered whole-brain or base skull radiotherapy.

Radiotherapy of large-volume disease is indicated because intra-CSF chemotherapy is limited by diffusion to 2 to 3 mm penetration into tumor nodules. In addition, involved-field irradiation can correct CSF flow abnormalities, and this has been shown to improve patient outcome, as previously discussed. Whole-neuraxis radiotherapy is rarely indicated in the treatment of LM from solid tumors because it is associated with significant systemic toxicity (severe myelosuppression and mucositis, among other complications) and is not curative.

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