Primary central nervous system lymphomas: natural history and response to radiation therapy in 55 patients with acquired immunodeficiency syndrome

Abstract

The incidence of primary central nervous system (CNS) lymphoma has increased rapidly in patients with acquired immunodeficiency syndrome (AIDS) and is predicted to exceed 1800 cases annually by 1991. To characterize the natural history and response to radiation therapy (RT) of these lesions, the authors have reviewed the clinical histories of 55 AIDS patients with biopsy-proven primary CNS lymphomas. The tumors responded both clinically and radiologically to whole-brain RT consisting of 4000 rad in 267-rad fractions over 3 weeks or an equivalent neuroret dose. The mean duration of survival from the appearance of symptoms consistent with the mass lesion was significantly greater in patients who received RT than in those who did not (42 vs. 134 days, p less than 0.5; median 27 vs. 119 days). Autopsy findings showed that patients who did not receive RT died from tumor progression, whereas those who completed RT died of opportunistic infections. Patients with AIDS who are suspected of having primary CNS lymphoma should therefore immediately undergo biopsy and, if the diagnosis is confirmed, whole-brain RT. With early diagnosis and treatment, these tumors respond to, and patients benefit from, RT. Survival of such patients may in future be prolonged by more effective treatments for systemic opportunistic infections.

Diagnostic delay in primary central nervous system lymphoma

“…In untreated patients, the prognosis of PCNSL is generally poor with a reported median survival of about 1 month for AIDS patients [1,2] and 2 Á/3 months for non-AIDS patients [3,4]. However, the median survival is 4 months in AIDS patients receiving radiotherapy [1,2] and 13 months in AIDS patients having combined radio-and chemotherapy [1]. In non-AIDS patients a median survival of up to 50 months and a five-year survival of 22 Á/43% has been reported in patients receiving only chemotherapy [5] or combined radio-and chemotherapy [6 Á/9].…”

Role of Autophagy in HIV-1 Matrix Protein p17-Driven Lymphangiogenesis

“…Furthermore, ARLs are usually high grade and aggressively metastatic (37), usually arising systemically and having a poor prognosis (38,39). Enhanced microvessel formation in lymph nodes of patients with ARLs has been clearly documented (7), and the hypothesis that p17 may be a key player in supporting lymphomagenesis is becoming one of the most consistent.…”

Diagnóstico y tratamiento de pacientes con linfomas primarios del sistema nervioso central (LPSN) y sindrome de inmunodeficiencia adquirida (SIDA).

“…El UCSF estudio anteriormente otro gran numero de pacientes con SIDA, en el cual se incluían 55 pacientes diagnosticados con LPSNC relacionado con SIDA (10). Algunos autores creen que la incidencia de linfomas relacionados con HIV (incluyendo el LPSNC) esta aumentando en la población HIV+ debido a un mejor control de la enfermedad con los nucleosios y los inhibidores de la proteasa y mejor control de las infecciones oportunistas (11).…”

“…Sin embargo el 77% de estos pacientes no recibieron la radiación adecuada ni la terapia completa debido a muerte por progresión del LPSNC. Entre el pequeño número de pacientes que si recibieron la radiación adecuada el 87% murieron de infecciones oportunistas sin evidencia del linfoma (10). Aunque algunos reportes de series pequeñas sugieren que la quimioterapia es de algún beneficio (13,(36)(37)(38) el uso de la quimioterapia o una modalidad de terapia combinada en pacientes con SIDA y LPSNC continua por establecerse.…”