Central nervous system lymphomas tend to spread widely through the brain and spinal cord making surgery difficult as a treatment option. Surgery is usually performed for biopsies to obtain a tumor sample and determine the cell type for diagnosis. Stereotactic biopsy with surgery is not commonly used with CNS lymphoma patients.

Treatment options are determined based on the patient’s age, cancer stage, its spread and whether it is recurring. Also, the patient's general health, including whether or not the patient has AIDS or other autoimmune diseases will determine the course of treatment.

As a result of immune system weakness, the cancer cells grow more aggressively in AIDS patients. AIDS patients often develop more severe side effects from treatment than other patients. Organ and heart transplant patients also are at high risk because the anti-rejection medication they take weakens their immune system.

Most patients with CNS lymphoma are treated with a combination of therapies, including:

• Chemotherapy. The use of powerful drugs given by injection or taken orally to control the growth of cancer cells by killing them or preventing cell division. Use of chemotherapy releases drugs into the bloodstream where they can reach cells throughout the body even to metastasized sites. When placed directly in locations such as the abdomen or spinal column, the drugs may mainly affect the cancer cells in those areas.
  
  Chemotherapy medications may also be placed in the central openings inside the brain (ventricles). The method of administration depends on where the cancer cells are located. Blood brain barrier disruption drugs may be used to make openings between cells to allow the chemotherapy drugs to penetrate the tumor.
  
  
• Lumbar puncture. If lymphoma cells are present in the spinal fluid, chemotherapy medications can be injected into the spinal canal (intrathecal chemotherapy). An Ommaya reservoir (a device with a very thin tube) can be inserted into the scalp to feed the drugs into the ventricles in the brain. This treatment may be preferred because it is more comfortable than repeated lumbar punctures.
  
  
• Radiation therapy. In external radiation, specialized x-ray beams are focused directly on targeted areas to kill or shrink cancer cells. Brachytherapy or internal radiation involves putting radioactive treatment materials, such as small “seeds,” directly into the site of the tumor.
  
  Because of potential damage to brain tissue with radiation therapy, clinical trials have tested chemotherapy alone or before radiation therapy to reduce damage to brain tissue. Radiation may be given if a considerable spread of the cancer is located along the cerebrospinal fluid pathway.
  
  
• Stereotactic radiotherapy. High dosage of radiation is directed at the cancer to reduce damage to surrounding brain tissue. This is a useful procedure in areas where debulking (stereotactic surgery) is not possible.
  
  
• Steroid therapy. Steroid hormones are made into drugs in the laboratory. Glucocorticoids (steroids with an anti-cancer effect), for example, are used to counteract the inflammation and growth of lymphomas.
  
  
• Biological therapy. This treatment, also called immunotherapy, is used to stimulate the immune system to fight cancerous cells as invaders. In some cases, biological therapy attacks the cancer directly.  Monoclonal antibodies are one type of biological therapy.
  

• Stem cell transplant. Stem cells (immature blood cells with the ability to form new replacement mature blood cells) are removed from the blood and bone marrow while high dose chemotherapy is administered. The stem cells are then infused into the blood and bone marrow to restore the patient’s blood supply. This treatment is being tested in clinical trials.

Treatment procedures for CNS lymphoma in patients with AIDS are different because side effects are more severe in these patients. Treatments often begin with steroid therapy and then may progress to include radiation and chemotherapy. A patient’s physicians will determine treatment of the disease based on a number of factors.

CNS lymphoma tends to produce distant disease as well as local recurrences. It recurs most often after it has been treated in the brain or the eye. Prognosis is based on the following factors:

• Patient’s age (prognosis is better under 60 years)
  
  
• Neurological damage and disability
  
  
• Level of impairment to functioning
  
  
• Whether the patient has AIDS (prognosis is better without AIDS)
  
  
• Cell type (obtained through biopsy)
  
  
• Cell grade (rate of aggressiveness of spread)
  
  
• Location and size of the tumors (prognosis is better if cells are contained in cerebrum, the largest part of the brain)
  
  
• Spread to cerebrospinal fluid and other parts of the brain and spinal cord

Prognosis without treatment after diagnosis is one to three months. Survival rate is three to four years or more with chemotherapy treatments. Younger patients have a better prognosis and chance of survival than older patients.