ADDITIONAL EXPERIENCE WITH EMPIRIC RADIOTHERAPY FOR PRESUMED HUMAN IMMUNODEFICIENCY VIRUS-ASSOCIATED PRIMARY CENTRAL-NERVOUS-SYSTEM LYMPHOMA

Background. In light of the steadily improving capability to treat opp ortunistic infections, the authors reviewed their recent experience wi th short course empiric radiotherapy for the treatment of human immuno deficiency virus (HIV)-associated presumed central nervous system (CNS ) lymphoma. Methods. Medical records were reviewed of 32 previously un reported HIV-infected patients who had computed tomography and/or magn etic resonance imaging findings consistent with lymphoma, whose lesion s had failed to respond to antitoxoplasmosis therapy and therefore sub sequently treated with empiric radiotherapy to the cranium and meninge s, nearly always 3000 cGy in 10 fractions. Results. The majority of pa tients were in poor general condition (median Karnofsky score = 50) wh en radiotherapy was initiated. Fifty percent improved during or after radiation. Median survival was 2.1 months. Conclusions. Despite progre ss made in the past several years in the treatment of opportunistic in fections and brief clinical response to radiotherapy, patients with ac quired immunodeficiency syndrome who have a presumed diagnosis of CNS lymphoma continue to have extremely poor survival. Early biopsy in pat ients with lesions that fail to respond to empiric antitoxoplasmosis t reatment or with lesions radiographically most consistent with lymphom a may improve outcome.