J Korean Neurosurg Soc. 2011 Oct; 50(4): 304-10
Kim JY, Kim ST, Nam DH, Lee JI, Park K, Kong DS
Intrathecal methotrexate (MTX) therapy combined with whole brain radiotherapy (WBRT) is one of a major treatment modalities for leukemia as well as lymphoma involving a central nervous system (CNS). The purpose of this study was to retrospectively determine a incidences of leukoencephalopathy as well as disseminated necrotizing leukoencephalopathy (DNL) following intrathecal MTX therapy for CNS lymphoma or leukemia as well as to assess a intensity risk factors.Between Jan 2000 as well as Aug 2009, 143 patients with CNS lymphoma or leukemia received intrathecal MTX therapy alone or in combination with WBRT at a single institution. Patients were followed up clinically as well as radiologically at regular two- or three-month intervals. Medical records were reviewed to obtain information regarding a patients' demographics, medical histories, radiologic characteristics, treatments, as well as clinical courses.On follow-up MR images, leukoencephalopathy was found in 95 of 143 patients (66.4%). The median time to develop leukoencephalopathy was 6.6 months. Among those with leukoencephalopathy, four patients showed seven extensive white-matter changes with strongly enhancing lesions demonstrating DNL. Histological confirmation was done in six lesions of three patients as well as radiological diagnosis alone in one patient. Four lesions spontaneously disappeared on MR images without any treatment, with a mean generation of 14 months prior to disappearance of DNL.Leukoencephalopathy is a common phenomenon which occurs following intrathecal MTX therapy; however, DNL occurs at a very low incidence. For newly developed enhancing lesions, consideration for a feeling of DNL should be taken to avoid unnecessary invasive procedures or therapies.
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