PRIMARY CENTRAL-NERVOUS-SYSTEM LYMPHOMA - RESULTS AT THE UNIVERSITY-OF-CALIFORNIA AT LOS-ANGELES AND REVIEW OF THE LITERATURE

The authors report 24 patients with primary central nervous system lym phoma (PCNSL) treated from 1977 to 1992. There were 13 females and 11 males. Median age was 57 (range: 17-84). Patients were symptomatic for a median of 3 months. Headache was the most common complaint. Median Karnofsky performance score was 70. There were 19 patients with solita ry PCNSL, and 5 had multiple deposits. Disease was confined to the sup ratentorium in 23 patients. Cerebrospinal fluid cytology was positive in 5 of 22 patients examined. All patients received whole-brain irradi ation with or without supplemental tumor boost. Tumor doses ranged fro m 10 to 60 Gy. Intrathecal chemotherapy was administered to 16 patient s and 7 received systemic agents. After follow-up ranging from 1 to 66 months, median survival and progression-free survival were each 8 mon ths. One- and 3-year actuarial survival rates were 50% and 36%, respec tively. One- and 3-year actuarial progression-free rates were 41% and 15%, respectively. Relapse occurred in 18 patients, and in 17 there wa s a component of local progression. Lesions recurred in the spinal men inges in 1 patients and in the vitreous in 1. Patients with Karnofsky performance status greater-than-or-equal-to 70 demonstrated median pro gression-free survival of 27 months, compared to 4 months for patients <70 (p = .024). No other significant patient or treatment-related pro gnostic factors were identified. Clinical dementia occurred in 2 of 11 patients surviving at least 1 year. Review of the literature indicate s PCNSL demonstrates relative radioresistance. The most immediate impr ovement in prognosis for patients with PCNSL can be achieved by proper ly sequencing systemic and intrathecal chemotherapy with radiation the rapy.