Treatment for lymphoma in the brain
Treatments for central nervous system lymphoma
Central nervous system lymphoma is also called CNS lymphoma. It is a rare type of brain or spinal cord tumour.
It is usually diagnosed on a scan. Your treatment team may want to confirm the diagnosis by taking a sample of cells from the tumour (a biopsy) during an operation. You may have a general anaesthetic for this.
You usually have chemotherapy as your first treatment if you are well enough. You may have chemotherapy into a vein with drugs that can get through the membrane that surrounds and protects the brain (the blood brain barrier). The main drug used is methotrexate and it is usually combined with other drugs. Sometimes steroids are used on their own.
Some people have chemotherapy injected into the fluid around the spinal cord (cerebrospinal fluid). This may be done in a procedure similar to having a lumbar puncture. Or you may have the drug injected into a small plastic capsule under the skin of the scalp (called an Ommaya reservoir). The drug circulates in the fluid around the brain and spinal cord to reach the lymphoma cells. This type of treatment is called intrathecal chemotherapy.
If chemotherapy does not control the lymphoma, you may have radiotherapy. You usually have radiotherapy treatment to the whole of your brain rather than treatment targeted just at the area of the lymphoma.
Central nervous system lymphoma is also called CNS lymphoma. It can either be primary (started in the CNS) or secondary (a lymphoma that began elsewhere in the body. This information is about primary CNS lymphoma.
In order to confirm that you have a primary CNS lymphoma you may need tests such as a CT scan. You may also have an HIV test (as this type of cancer can sometimes be linked to HIV).
Primary CNS lymphoma can respond reasonably well to chemotherapy. You usually have chemotherapy as your first treatment. You will be given chemotherapy into a vein often via a special line called a Hickman or PICC line.
The main drug used is methotrexate You have it as a drip with another drug that makes your urine alkaline so it doesn't damage your kidneys. You also have a drug called folinic acid to reduce the methotrexate side effects. The methotrexate may be combined with other drugs such as cytarabine, procarbazine, vincristine or lomustine. Usually you have chemotherapy with the steroid drug, dexamethasone.
You may have methotrexate injected into the fluid around your spinal cord (the cerebrospinal fluid). This is similar to having a lumbar puncture.
The drug then circulates in the fluid around the brain and spinal cord to reach the lymphoma cells. This type of treatment is called intrathecal chemotherapy.
After a number of treatment cycles of these drugs you have a scan to see how well the treatment is working. If it is working well you have more chemotherapy. If it is not working well your treatment team may recommend changing to radiotherapy treatment.
You usually have radiotherapy treatment to the whole of your brain as well as a targeted treatment (boost dose) to the area of the lymphoma. This treatment lowers the risk of lymphoma cells spreading to other areas of the brain.
Radiotherapy treatment may also be used instead of chemotherapy if you are not well enough to have chemotherapy treatment.
If you have questions about central nervous system lymphoma treatment you may find information in our section about brain tumour treatment.
You can find information about the outlook (prognosis) for these tumours on the brain tumour statistics and outlook page.
You are also welcome to contact the Cancer Research UK nurses on freephone 0808 800 4040. Lines are open from 9am to 5pm, Monday to Friday.
You can contact one of the brain tumour organisations or look at our brain tumour reading list. If you want to find people to share experiences with online, you could use CancerChat, our online forum.
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