Primary lymphoma of the central nervous system. An unresolved therapeutic problem

Abstract

From January 1979 to December 1987, 35 cases of primary central nervous system lymphoma (CNS-L) were treated. We recently reviewed these cases focusing on treatment results, treatment modalities, and radiotherapy (RT) or chemotherapy-radiotherapy (CT-RT). Variables such as age, risk factors, presenting symptoms, and histologic condition (all were high-grade or intermediate-grade non-Hodgkin's lymphomas [NHL]) and radiologic data were similar to those of series reported previously. The median survival time was 36 months (+/- 0.2 months) and the disease-free survival (DFS) time was 16 months (+/- 0.12 months). Twelve of 32 patients evaluable for treatment results experienced a recurrence (all but one occurred in the CNS). The DFS rate was 70% for the CT-RT group and 50% for the RT group (median follow-up time, 24 months). Therapeutic results in CNS-L are discussed with special emphasis on a putative role of CT in the management of this rare type of tumor.

Primary central nervous system lymphoma: a role for adjuvant chemotherapy

“…Primary CNS non-Hodgkins lymphomas are rare tumors that represent 0.5% to 1.2% of all CNS tumors and about 2% of all lymphomas [3][4][5][6]. Primary CNS lymphomas account for > 90% of all parenchymal CNS lymphomas, whereas the overwhelming majority of leptomeningeal lymphomas arise from metastatic systemic non-Hodgkins lymphomas.…”

“…A number of chemotherapeutic regimens have been evaluated in the treatment of immunocompetent patients with primary CNS lymphoma both in the adjuvant and recurrent setting [1,[3][4][5][6][12][13][14][15][16][17]. Given the large number of drugs active against extraneural non-Hodgkins lymphoma, it is not surprising to find a variety of drugs employed against primary CNS lymphoma.…”

Primary central nervous system lymphoma

“…Murray et al recorded a male: female ratio of 1.5 : 1 among the 693 cases reviewed. More recent reports of PCNSL estimate the male: female ratio as ranging between 1 : 1 and 4 : 1 (Hochberg & Miller 1988;Brada et al 1990;Socie et al 1990;Neuwelt et al 1991;DeAngelis et al 1992a;Rosenthal et al 1993;Tomlinson et al 1995;Glass et al 1996;Trans-Tasman Radiation Oncology Group 1996;Cher et al 1996;Brada et al 1998;Wagner et al 1998). This slight male predominance mirrors the male predominance noted in systemic lymphomas (DeVita et al 1997).…”

“…The age range in this series was 2 months to 90 years. More recent series have reported median ages at diagnosis ranging from 48-58 years (Hochberg & Miller 1988;Socie et al 1990;Neuwelt et al 1991;DeAngelis et al 1992a;Rosenthal et al 1993;Tomlinson et al 1995;Glass et al 1996;Trans-Tasman Radiation Oncology Group 1996;Cher et al 1996;Brada et al 1998;Wagner et al 1998). Reports of PCNSL in childhood are rare and are usually associated with inherited or acquired immunosuppression (Helle et al 1984;Epstein et al 1988;Kai et al 1998).…”

Non-Hodgkin's Lymphomas (NHL)

“…Attempts to improve results with combined radivt herapy and chemotherapy have been reported in eight small pilot studies using different types of chemotherapy drugs prior to or following radiotherapy (41,84,(89)(90)(91)(92)(93). Fivc of these studies reported a longer median survival (20 + to 60 months) with combination therapy than with radiotherapy alone (41, 84, 89-91).…”