Primary lymphomas of the central nervous system: patterns of failure and factors that influence survival.

Abstract

Primary lymphomas of the CNS are rare tumors accounting for less than 2% of all extranodal non-Hodgkin's lymphomas. The treatment for this disease has been disappointing. Radiation therapy and surgery have produced consistently poor control of this disease, with a median survival of 15 months. We have reviewed ten cases of primary lymphoma of the CNS treated at the Joint Center for Radiation Therapy or Dana-Farber Cancer Institute (Boston) from 1968 to 1981. All patients had biopsy-proven CNS lymphomas without systemic disease at presentation. In our series, control of CNS lymphoma was seen only in patients receiving craniospinal radiation or CNS-penetrating chemotherapy.

Multivariate analysis of prognostic factors in patients with non HIV-related primary cerebral lymphoma. A proposal for a prognostic scoring

“…Survival in this series is comparable to that previously reported in the literature for PCL (Murray et al, 1987;Hochberg & Miller, 1988). Our data confirm previous observations indicating that age, performance status, and hemispheric location of the tumour are prognostic factors in PCL (Murray et al, 1986;Mendenhall et al, 1986;Loeffler et al, 1985;Pollack et al, 1989;Michalski et al, 1990 (Byar et al, 1979) and renal cell carcinoma (Elson et al, 1988) and can be easily used for medical decision making.…”

“…Furthermore, comparison of therapeutic results between studies is complicated by the differences in the clinical presentations of this disease and the lack of knowledge of prognostic factors. Several univariate analyses, most involving less than 30 patients, have identified prognostic factors for survival in patients with PCL ) Loeffler et al, 1985;Murray et al, 1986;Mendenhall et al, 1986;Pollack et al, 1989;Michalski et al, 1990). Some of these prognostic factors are identical to those previously shown for aggressive lymphomas not involving the CNS, such as age, performance status at diagnosis, size of the lesion, and serum LDH levels.…”

“…Specific prognostic factors for PCL, such as confinement of the tumour to cerebral hemispheres and extension of the tumour outside the brain have also been reported (Murray et al, 1986;Loeffler et al, 1985;Pollack et al, 1989;Michalski et al, 1990). Among therapeutic features, the dose of radiation (Murray et al, 1986;Berry & Simpson, 1981;Pollack et al, 1989;Brada et al, 1990) and treatment with chemotherapy (Pollack et al, 1989;Michalski et al, 1990;Shibamato et al, 1989) The three remaining patients were treated with radiotherapy only because of patient refusal.…”

Second-line treatment for primary central nervous system lymphoma

“…Complete data of disease-free survival (DFS), overall survival (OS) and management of recurrent or progressive disease after first-line treatment were available for each patient in 24 out of 59 considered series (Sagerman et al, 1967;Rampen et al, 1980;Letendre et al, 1982;Gonzalez and Schuster-Uitterhoeve, 1983;Mendenhall et al, 1983;Loeffler et al, 1985;Woodman et al, 1985;Di Marco et al, 1986;Murray et al, 1986;Vakili et al, 1986;Yasunaga et al, 1986;McLaughlin et al, 1988;Shibamoto et al, 1990;Uematsu et al, 1992;Watne et al, 1992;Boiardi et al, 1993;Glass et al, 1994Glass et al, , 1996Lachance et al, 1994;Ling et al, 1994;Selch et al, 1994;Ferreri et al, 1995b;Sarazin et al, 1995;Freilich et al, 1996). Three hundred and fiftyfive cases were reported in the analysed series: 334 patients received RT, CHT or CTM as first-line treatment, whereas 21 patients were not submitted to any therapy after diagnosis.…”

Phase II Multicenter Study of Brief Single-Agent Methotrexate Followed by Irradiation in Primary CNS Lymphoma

“…3 Its tropism for the CNS, which remains largely unexplained, and low rates of systemic dissemination logically led to the use of radiotherapy alone as definitive management. [5][6][7][8][9] Despite doses of radiotherapy that would be expected to control most non-Hodgkin's lymphomas at other sites, local failure was extremely common. 10 This propensity for local recurrence was best demonstrated in a large phase II study performed by the Radiation Therapy Oncology Group, in which doses of 50 to 60 Gy were delivered to macroscopic disease.…”