Primary central nervous system lymphoma: long-term survival following treatment with radiation and methotrexate

Primary lymphoma of the central nervous system is a rare disease with poor response to therapy. A 37-year-old man presented with primary cerebral lymphoma diagnosed by stereotactic brain biopsy. He was initially treated with whole brain irradiation but subsequently developed recurrent disease in the spinal cord manifested by paraplegia. Combined modality treatment with spinal cord irradiation, intrathecal methotrexate and 19 courses of high-dose systemic methotrexate with urinary alkalinization, resulted in stabilization of his neurologic status. No further disease progression has been observed and the patient remains free of disease 62 months after beginning chemotherapy. Methotrexate therapy may offer an effective means of treating recurrent primary central nervous system lymphomas.