SHORT INTENSIVE PRIMARY CHEMOTHERAPY AND RADIOTHERAPY IN SPORADIC PRIMARY CNS LYMPHOMA (PCL)

Purpose: To assess the efficacy and toxicity of combined modality ther apy with short intensive primary chemotherapy in the treatment of prim ary CNS lymphoma (PCL). Methods and Materials: Prospective study of 31 nonimmunodeficient patients with PCL treated with initial chemotherap y (13 shortened MACOP-B; and 18 modified MACOP with high dose methotre xate) followed by radiotherapy (whole brain and a boost), Patients mer e aged 18-72 years (median 51 Sears), Eight patients had positive CSF cytology of which one had spinal meningeal disease; one patient had vi treous involvement, Results: The overall complete response (CR) rate a fter chemotherapy and radiotherapy was 69% (95% Confidence Interval: 4 9-84%). At a median follow-up of 24 months (4 months to 10 years) medi an survival was 23 months and 5-year survival 34%. Age, sex, performan ce status, number of lesions, CSF cytology, and extent of surgery mere not of prognostic significance for survival on univariate analysis, E leven patients developed mucositis (Grade 3+) and 21 hematological tox icity (Grade 3+) with 22 septicemic episodes in 15 patients, Three pat ients developed dementia, one assumed to be treatment related, and two due to recurrent disease, Conclusion: The survival results of short i ntensive primary chemotherapy followed by radiotherapy are similar to the results of chemotherapy in Stage IV aggressive systemic non-Hodgki n's lymphoma, although the treatment was associated with high morbidit y, The apparently favorable results when compared to radiotherapy alon e mag at least in part be due to selection of patients with good progn ostic factors, To confirm the benefit of combined chemotherapy and rad iotherapy over either of the two modalities alone requires evaluation in large prospective and ideally randomized studies. (C) 1998 Elsevier Science Inc.