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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Prof. Dr. med. Uwe Schlegel
Neurologische Universitätsklinik Bonn
Sigmund-Freud-Straße 25
53105 Bonn
Email: uwe.schlegel@uni-bonn.de
