Stereotactic Brachytherapy with Iodine-125 Seeds Plus Temozolomide Induced Complete and Durable Remission in a Patient with Recurrent Primary Central Nervous System Lymphoma

World Neurosurg. 2018 Sep:117:316-320. doi: 10.1016/j.wneu.2018.06.150. Epub 2018 Jun 27.

Abstract

Background: The optimal treatment of recurrent primary central nervous system lymphoma (PCNSL) has not yet been determined. We report a patient with recurrent PCNSL who has been successfully treated with stereotactic brachytherapy (SBT) with iodine-125 seeds plus temozolomide (TMZ).

Case description: A 51-year-old man who underwent left occipital lobe tumor resection 11 years earlier presented with a 1-month history of right hand weakness. Magnetic resonance imaging (MRI) revealed a recurrent PCNSL, which was confirmed by pathological examination. He was treated with SBT plus TMZ. At 1 month after surgery, a repeat MRI revealed nearly complete disappearance of the lesion. At 13.5 months postsurgery, the patient was neurologically intact except for right homonymous hemianopia, and follow-up MRI did not reveal a recurrent tumor.

Conclusions: To our knowledge, this is the first case of recurrent PCNSL successfully treated with SBT plus TMZ. Further randomized studies are needed to confirm the therapeutic impact of this new method.

Keywords: Iodine-125 seeds; Primary central nervous system lymphoma; Recurrent stereotactic brachytherapy; Temozolomide.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents, Alkylating / therapeutic use*
  • Brachytherapy* / methods
  • Central Nervous System Neoplasms / diagnostic imaging
  • Central Nervous System Neoplasms / therapy*
  • Combined Modality Therapy
  • Dacarbazine / analogs & derivatives*
  • Dacarbazine / therapeutic use
  • Humans
  • Iodine Radioisotopes / therapeutic use
  • Lymphoma, Non-Hodgkin / diagnostic imaging
  • Lymphoma, Non-Hodgkin / therapy*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Recurrence, Local / therapy*
  • Neurosurgical Procedures
  • Radiosurgery / methods
  • Remission Induction
  • Temozolomide

Substances

  • Antineoplastic Agents, Alkylating
  • Iodine Radioisotopes
  • Dacarbazine
  • Temozolomide