Real-time intracranial pressure monitoring during high-dose methotrexate treatment for primary central nervous system lymphoma.
Cerebral edema
Cns lymphoma
High-dose methotrexate
ICP Monitoring
Journal
Cancer treatment and research communications
ISSN: 2468-2942
Titre abrégé: Cancer Treat Res Commun
Pays: England
ID NLM: 101694651
Informations de publication
Date de publication:
2020
2020
Historique:
received:
07
05
2020
revised:
27
10
2020
accepted:
30
10
2020
pubmed:
9
11
2020
medline:
18
11
2021
entrez:
8
11
2020
Statut:
ppublish
Résumé
Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin lymphoma with exclusive central nervous system (CNS) and/or ocular involvement. Increased intracranial pressure (ICP) from cerebral edema can commonly presents secondary to the mass effect of PCNSL. Methotrexate-based induction chemotherapy is the gold standard for treatment, however, several neurotoxic complications have been associated with high-dose methotrexate (HD-MTX) treatment. Tumor lysis and other biochemical disruptions following administration of HD-MTX are postulated to increase cerebral edema and ICP in predisposed patients, therefore, in the setting of ring-enhancing lesions with significant mass effect, monitoring of ICP to prevent cerebral herniation may be necessary. We present the case of a patient with diffuse cerebral edema secondary to PCNSL, who was treated with methotrexate-based induction chemotherapy and underwent real-time ICP monitoring to allow for early recognition, and management with aggressive medical therapy to prevent worsening cerebral edema and potential fatal herniation. Treatment of patients with high tumor burden PCNSL can prove to be challenging, particularly at the time of initiation of methotrexate based induction chemotherapy in the setting of impending cerebral herniation, as in the case presented. Close monitoring of the patient's ICP proved advantageous in rapidly recognizing, and successfully treating elevations in ICP that could have worsened mass effect and lead to fatal herniation.
Sections du résumé
BACKGROUND
Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin lymphoma with exclusive central nervous system (CNS) and/or ocular involvement. Increased intracranial pressure (ICP) from cerebral edema can commonly presents secondary to the mass effect of PCNSL. Methotrexate-based induction chemotherapy is the gold standard for treatment, however, several neurotoxic complications have been associated with high-dose methotrexate (HD-MTX) treatment. Tumor lysis and other biochemical disruptions following administration of HD-MTX are postulated to increase cerebral edema and ICP in predisposed patients, therefore, in the setting of ring-enhancing lesions with significant mass effect, monitoring of ICP to prevent cerebral herniation may be necessary.
PRESENTATION OF CASE
We present the case of a patient with diffuse cerebral edema secondary to PCNSL, who was treated with methotrexate-based induction chemotherapy and underwent real-time ICP monitoring to allow for early recognition, and management with aggressive medical therapy to prevent worsening cerebral edema and potential fatal herniation.
DISCUSSION AND CONCLUSIONS
Treatment of patients with high tumor burden PCNSL can prove to be challenging, particularly at the time of initiation of methotrexate based induction chemotherapy in the setting of impending cerebral herniation, as in the case presented. Close monitoring of the patient's ICP proved advantageous in rapidly recognizing, and successfully treating elevations in ICP that could have worsened mass effect and lead to fatal herniation.
Identifiants
pubmed: 33161322
pii: S2468-2942(20)30069-1
doi: 10.1016/j.ctarc.2020.100234
pii:
doi:
Substances chimiques
Methotrexate
YL5FZ2Y5U1
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100234Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.