Combined high-dosage polychemotherapy as efficient single therapy of primary cerebral lymphomas

The incidence of primary CNS lymphomas is steadily increasing. A curative t herapeutic regimen could not yet be established. Radiotherapy is palliative only with a mean survival of 12 to 18 months after diagnosis. A combinatio n of whole brain irradiation and chemotherapy may increase mean survival up to four years; however, late neurotoxic sequelae are severe and affect abo ut half of the surviving patients. We report on eight patients (mean age 57 ys) who were treated with combined intraventricular/ systemic chemotherapy only, based on a high-dosage MTX- and Ara-C regimen. Seven of the eight pa tients showed complete tumour remission after therapy; in one case treatmen t-related toxicity led to death of a 71-year old man. The mean recurrence-f ree interval is more than 15 months already, and six patients continue to b e in complete remission. in one patient, the tumour recurred after 22 month s, and showed complete remission again after administration of chemotherapy alone. Therapy-related neurotoxicity was not observed, and it is discussed whether chemotherapy alone should be the treatment of first choice in this tumour type.