Lymphoma of the Nervous System
http://www.100md.com
《新英格兰医药杂志》
During the past two decades, the rate of diagnosis of primary central nervous system lymphoma has more than doubled. Yet even though nearly 3 percent of brain tumors are primary central nervous system lymphomas, the various nonsurgical treatments for this disease remain unfamiliar territory to many neurologists, medical oncologists, and even experts on lymphoma. The management of the disease has drastically changed, and a growing number of patients now have a chance of a cure. Still, it is a tough disease to treat successfully. Complications of the treatment can be devastating, both in the short term and in the long term. This book, the first devoted primarily to the disease, provides a comprehensive source for the study of the clinical features, diagnostic aspects, and approaches of lymphoma treatment. Although the main focus of the book is primary central nervous system lymphoma, several contributing authors also provide high-quality chapters on the neurologic manifestations of non-Hodgkin's lymphoma, Hodgkin's disease, and plasma-cell disorders and the neurologic complications of lymphoma therapy.
Advances in imaging and stereotactic biopsy allow the fast and accurate diagnosis and staging of primary central nervous system lymphoma. The "therapeutic trial" of the past with steroids is discouraged, and as is not true in the case of most other brain tumors, surgical resection is counterproductive. Radiotherapy alone, the mainstay of past treatment, yielded dramatic improvement, but a relapse usually occurred in only a matter of months. Even standard treatment with doxorubicin-based chemotherapy provided no cure. The breakthrough came with the introduction of high-dose methotrexate-based regimens, followed by whole-brain radiotherapy. This combination tripled the previous median survival time achieved with irradiation alone, and some studies indicate that almost a quarter of the patients with the disease now survive more than five years. Yet the optimal treatment approach for primary central nervous system lymphoma is still evolving, and important components of therapy remain controversial. The chapter on treatment should have provided more details about regimens and comparisons of results and offered guidelines and tips familiar to the experts to assist the practicing oncologist.
The most controversial aspect of treatment is the role of whole-brain radiotherapy after methotrexate-based chemotherapy. Adding radiotherapy increases the risk of devastating neurologic complications (mostly in older patients) that appear even if the disease is in remission. Yet without radiotherapy, the relapse rate is high. The book could have benefited from the contribution of a radiation oncologist in discussing the choice of fields and dosing techniques with various clinical scenarios.
In the course of diagnosis, treatment, and follow-up, the patient will be seen by practitioners in many specialties — internal medicine, neuroradiology, neurosurgery, pathology, general neurology, neuro-oncology or medical oncology, radiation oncology, ophthalmology, and possibly psychiatry and rehabilitation. Many of the experts practicing outside a few major cancer centers have only limited experience with this disease. This book — up to date, concise, and clearly written — provides a review of the disease that is more in-depth than that found even in subspecialty textbooks.
Joachim Yahalom, M.D.
Memorial Sloan-Kettering Cancer Center
New York, NY 10021
yahalomj@mskcc.org(Edited by Tracy T. Batche)
Advances in imaging and stereotactic biopsy allow the fast and accurate diagnosis and staging of primary central nervous system lymphoma. The "therapeutic trial" of the past with steroids is discouraged, and as is not true in the case of most other brain tumors, surgical resection is counterproductive. Radiotherapy alone, the mainstay of past treatment, yielded dramatic improvement, but a relapse usually occurred in only a matter of months. Even standard treatment with doxorubicin-based chemotherapy provided no cure. The breakthrough came with the introduction of high-dose methotrexate-based regimens, followed by whole-brain radiotherapy. This combination tripled the previous median survival time achieved with irradiation alone, and some studies indicate that almost a quarter of the patients with the disease now survive more than five years. Yet the optimal treatment approach for primary central nervous system lymphoma is still evolving, and important components of therapy remain controversial. The chapter on treatment should have provided more details about regimens and comparisons of results and offered guidelines and tips familiar to the experts to assist the practicing oncologist.
The most controversial aspect of treatment is the role of whole-brain radiotherapy after methotrexate-based chemotherapy. Adding radiotherapy increases the risk of devastating neurologic complications (mostly in older patients) that appear even if the disease is in remission. Yet without radiotherapy, the relapse rate is high. The book could have benefited from the contribution of a radiation oncologist in discussing the choice of fields and dosing techniques with various clinical scenarios.
In the course of diagnosis, treatment, and follow-up, the patient will be seen by practitioners in many specialties — internal medicine, neuroradiology, neurosurgery, pathology, general neurology, neuro-oncology or medical oncology, radiation oncology, ophthalmology, and possibly psychiatry and rehabilitation. Many of the experts practicing outside a few major cancer centers have only limited experience with this disease. This book — up to date, concise, and clearly written — provides a review of the disease that is more in-depth than that found even in subspecialty textbooks.
Joachim Yahalom, M.D.
Memorial Sloan-Kettering Cancer Center
New York, NY 10021
yahalomj@mskcc.org(Edited by Tracy T. Batche)