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Erschienen in:

01.03.2009 | Leitthema

Primäre ZNS-Lymphome

verfasst von: Prof. Dr. U. Schlegel, A. Korfel, E. Thiel, W. Wick, R. Kortmann, M. Deckert, G. Schackert

Erschienen in: Die Onkologie | Ausgabe 3/2009

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Zusammenfassung

Primäre ZNS-Lymphome (PZNSL) gehören zu den seltenen Gehirntumoren. Sie machen etwa 3% aller primären intrakraniellen Neubildungen aus; das mediane Erkrankungsalter liegt zwischen 60 und 65 Jahren. PZNSL führen häufig zu einem rasch progredienten Psychosyndrom und zeigen sich in der Magnetresonanztomographie (MRT) oft als multifokale oder unifokale, intensiv kontrastmittelaufnehmende Läsionen, häufig in der Nachbarschaft zu den Ventrikeln. Die diagnostische Maßnahme der Wahl ist die stereotaktische Biopsie, die bei mehr als 90% der Patienten ein hoch malignes Non-Hodgkin-Lymphom (NHL) der B-Zell-Reihe vom diffus-großzelligen Typ zeigt. Da weiterhin eine Therapieoptimierung der PZNSL angestrebt wird, sollten Patienten innerhalb klinischer Studien behandelt werden. Bei Patienten unter 60 Jahren ist das Therapieziel kurativ. Jungen Patienten sollte eine Polychemotherapie unter Einschluss von systemischem hochdosiertem Methotrexat (MTX) angeboten werden. Der Stellenwert einer myeloablativen Hochdosischemotherapie mit autologer Stammzelltransplantation in der Primärtherapie ist noch nicht abschließend geklärt. Für Patienten über 60 Jahre ist noch keine kurative Therapie etabliert. Außerdem spielt die Toxizität eine noch größere Rolle. Bei diesen Patienten kann eine MTX-basierte Chemotherapie, z. B. in Kombination mit Ifosfamid oder Temozolomid, eingesetzt werden. Die alleinige Radiotherapie in der Primärbehandlung wird nicht empfohlen. Ihr Stellenwert in Kombination mit einer MTX-basierten Chemotherapie ist ebenfalls nicht etabliert, sie ist jedoch insbesondere bei älteren Patienten mit einer hohen Rate neurotoxischer Spätfolgen verbunden. Im Rezidiv gibt es in der Regel gute Behandlungsmöglichkeiten, deren Auswahl von der Primärtherapie abhängt. In Deutschland gibt es mehrere Studienkonsortien, die wesentliche Arbeiten zur Optimierung der Therapie dieser Tumoren geleistet haben und die sich in enger Diskussion austauschen.
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Metadaten
Titel
Primäre ZNS-Lymphome
verfasst von
Prof. Dr. U. Schlegel
A. Korfel
E. Thiel
W. Wick
R. Kortmann
M. Deckert
G. Schackert
Publikationsdatum
01.03.2009
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 3/2009
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-009-1573-8

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