Improved survival rate in primary intracranial lymphoma treated by high-dose radiation and systemic vincristine-doxorubicin-cyclophosphamide-prednisolone chemotherapy

Article Abstract:

Lymphomas, tumors of the lymphatic system, rarely occur within the skull, but their incidence is increasing. Only part of this increase can be attributed to an increase in the numbers of immunosuppressed patients, due to organ transplantation and AIDS; the rate of spontaneous intracranial lymphoma seems to be rising as well. The survival rate for intracranial lymphoma is poor, and only 10 percent may be expected to survive past five years. In most cases, the patient succumbs to local recurrence of tumor; it is clear that radiation alone is generally insufficient to achieve local control. Chemotherapy has been infrequently used with patients within intracranial lymphoma, despite its effectiveness when used against lymphomas at other sites. This may be due to confusion in some clinician's minds about the blood-brain barrier. The blood-brain barrier excludes many substances, including most chemotherapeutic compounds, from entering the brain, and poses fundamental problem for the treatment of many brain tumors. However, research has shown that the blood-brain barrier is broken down in the vicinity of lymphomas, and these tumors are therefore not shielded from the effects of circulating drugs, unlike other brain tumors. A review of patient records revealed a total of 30 patients with intracranial lymphoma; none of these patients were immunosuppressed. Sixteen patients were treated prior to 1980 with radiation, only 1 survived more than five years. In 1981, the authors instituted a protocol involving whole brain irradiation at 30-40 Gy (a Gy, or Gary, is 1 joule of energy absorbed per kilogram of tissue) with a boost to the tumor area of 50-60 Gy. The radiotherapy was followed by chemotherapy with a combination of vincristine, doxorubicin, cyclophosphamide, and prednisolone. Eight patients completed this treatment protocol. Three patients have lived beyond five years, and only one has so far developed recurrence. The treatment protocol apparently represents an improvement in terms of survival, but two patients developed brain necrosis (tissue death) resulting from the treatment. The necrosis was fatal in one. Two others are in a poor state; the chemotherapy seems to enhance the deleterious effects of the radiation on the brain. Future research will focus on modifying the doses to determine if the improved survival can be retained while the serious effects are reduced or eliminated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Radiotherapy, Lymphomas, Brain cancer, Vincristine, Prednisolone

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Pulmonary metastases from ameloblastoma of the mandible treated with cisplatin, adriamycin, and cyclophosphamide

Article Abstract:

Ameloblastoma is a tumor which resembles the tissues that give rise to tooth enamel. These tumors account for about 1 percent of the tumors of the upper and lower jaw. Ameloblastoma is generally considered to be benign. However, it is well documented that in a small minority of cases, ameloblastoma can metastasize (spread) to distant parts of the body. This metastatic potential of ameloblastoma was illustrated in the recent case of a woman who developed a pulmonary metastasis 20 years after the original diagnosis and surgical removal of the primary ameloblastoma in her jaw. After seeking medical care for a history of cough lasting more than one year, the patient was found to have multiple pulmonary tumors which were found on biopsy to be ameloblastoma. Examination of the site of the primary tumor revealed no evidence of activity. The multiple lesions precluded surgical removal of the tumors, and the patient was treated with a combination of cisplatin, adriamycin, and cyclophosphamide. She showed great symptomatic improvement, but chemotherapy was repeated due to evidence of residual lesions on X-ray. The patient seems to be doing well 10 months after chemotherapy. This case has several features which appear to be common among the few published reports of metastatic ameloblastoma: the occurrence of metastatic spread is significantly delayed, and the most common site of metastasis is the lungs. However, unlike most reported cases, this patient did not have evidence of tumor activity at the primary site when the metastatic tumors were diagnosed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Metastasis, Cancer metastasis, Lung cancer, Mouth cancer, Cisplatin, Ameloblastoma

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