ABSTRACT
OBJECTIVE: Patients with non-acquired immunodeficiency syndrome-related primary central nervous system lymphomas have the potential to achieve durable complete responses without radiotherapy, with treatment using enhanced chemotherapy delivery with blood-brain barrier disruption (BBBD). Reported 5-year survival rates with combined chemotherapy and radiotherapy were generally only 9 to 22% and were associated, in one study, with an overall 32% incidence of overt dementia and ataxia, which are dramatically increased among patients more than 60 years of age. METHODS: At the Oregon Health Sciences University, 111 consecutive patients with non-acquired immunodeficiency syndrome-related central nervous system lymphomas were prospectively treated with methotrexate-based, BBBD-enhanced chemotherapy and underwent formal neuropsychological evaluations. Of those, 74 patients had no systemic lymphoma and had received no prior irradiation; those 74 patients are described in this report. RESULTS: The estimated 5-year survival rate for this group was 42%, and the median survival time was 40.7 months. Overall, 48 patients (65%) exhibited complete responses and 36 patients continued to exhibit complete responses after 1 year of BBBD-enhanced chemotherapy. Of those 36 patients, none demonstrated evidence of cognitive loss in neuropsychological tests and/or clinical examinations. CONCLUSION: BBBD-enhanced chemotherapy delivery, without subsequent radiotherapy, resulted in favorable survival and cognitive outcomes for patients with primary central nervous system lymphomas who had not previously undergone irradiation. A cooperative multicenter study of intravenous chemotherapy without radiotherapy versus BBBD-enhanced chemotherapy would address the feasibility and necessity of performing a Phase III study for these rare central nervous system malignancies.
Subject(s)
Antimetabolites, Antineoplastic/therapeutic use , Brain Neoplasms/drug therapy , Lymphoma/drug therapy , Methotrexate/administration & dosage , Blood-Brain Barrier , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neuropsychological Tests , Prospective Studies , Remission Induction , Time FactorsABSTRACT
On September 6, 1984, industrial bans were placed on the movement of linen within The Royal Melbourne Hospital. Initially, linen was stored in ward areas and, later, on hospital balconies. The dispute was not settled for 14 days; by this time, 25 beds and the Emergency Department had been closed. Stockpiled "soiled" and "infectious" linen bags posed a major safety risk. Once the bans were lifted, linen was removed and laundered under supervision, according to a carefully planned programme, in order to minimize the exposure of patients and staff members to potential cross-infection. Recommendations are made to cover infection control aspects associated with industrial disputes of this nature.