Temozolomide regulates primary central nerve system lymphoma, being resistant to high dose methotrexate-based chemotherapy and radiation

Introduction: Primary central nerve system lymphoma (PCNSL) is an intracranial malignancy. Combined chemotherapy with methotrexate, procarbazine, vincristine, and Rituximab, following radiation, sometimes results in partial response or progressive disease. Temozolomide (TMZ) administration has been proposed to salvage therapy. Case Report: A 72-year-old man had headache and forgetfulness. Mild disorientation was observed. Head magnetic resonance image revealed a mass lesion in the right frontal lobe. Pathological examination after an incisional biopsy revealed a diagnosis of diffuse large B cell lymphoma. Standard treatment consisted of 6 cycles of high-dose methotrexate-based chemotherapy with procarbazine and vincristine. Three cycles of high-dose methotrexate-based chemotherapy with procarbazine and vincristine, combined with Rituximab. Further, focal radiation therapy against core lesion with marginal area irradiation was performed. In spite of total standard treatment, the lesion was not under regulation. The patient continued TMZ therapy 29 cycles on an outpatient basis due to psychiatric complications that made it difficult to continue intravenous treatment in the hospital. The tumor mass and surrounding edematous lesions decreased. Conclusion: Oral TMZ administration was effective in an elderly patient with PCNSL, who had failed standard chemotherapy and radiation therapy. It was less invasive, allowed for transition to outpatient management, and provided adequate therapeutic benefit. Future indications for similar cases should be considered.