Therapie primärer zerebraler Lymphome

Zusammenfassung

Die Therapie der Primären ZNS Lymphome (PZNSL) ist in Deutschland uneinheitlich, weil es keine verbindliche Behandlungsempfehlung gibt. Systemisches Hochdosis Methotrexat (MTX) ist zwar ein wesentlicher Therapiebestandteil, MTX allein führt jedoch nach den in Deutschland gemachten Erfahrungen nur bei etwa der Hälfte der Patienten zu einer Remission. Ob MTX durch eine Strahlentherapie oder durch weitere Chemotherapeutika ergänzt werden muss, um die Therapie zu verbessern, ist Gegenstand kontroverser Diskussion und prospektiver Therapiestudien. Wegen der großen Gefahr neurotoxischer Langzeitfolgen nach Hochdosis MTX und Radiatio bei Patienten über 60 Jahre favorisieren die Autoren eine Polychemotherapie ohne Bestrahlung.

Therapy of Primary CNS Lymphoma

Therapy of primary CNS lymphoma (PCNSL) is not yet established. The introduction of systemic high-dose methotrexate (MTX) in its treatment has been a therapeutic breakthrough. However, according to German experience, high dose MTX alone achieves remissions only in about half of the patients. If MTX has to be supplemented by other cytostatic drugs or if it has to be combined with subsequent whole brain radiotherapy in order to improve treatment outcome is a matter of debate and is investigated in ongoing prospective trials in Germany. Since neurotoxic long-term effects are frequent and severe after combined MTX-chemotherapy and radiotherapy in patients over 60 years of age, the authors favor the systematic evaluation of „chemotherapy alone” protocols in this disease.

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