PRIMARY CENTRAL-NERVOUS-SYSTEM LYMPHOMA - AGE AND PERFORMANCE STATUS ARE MORE IMPORTANT THAN TREATMENT MODALITY

Purpose: To assess prognostic factors and treatment modalities of pati ents with primary central nervous system lymphoma (PCNSL) in terms of response rates, patterns of failure and overall survival. Methods and Materials: Sixty-two patients presenting with PCNSL between 1982 and 1 994 at Peter MacCallum Cancer Institute with no evidence of human immu nodeficiency virus infection were included in the study. Their median age was 60 years; World Health Organisation (WHO) performance status w as greater than or equal to 2 in 85%. An patients were planned to rece ive whole brain irradiation; 7 also received spinal irradiation. The m edian planned dose to the target volume was 50.4 Gy. Twenty patients w ere planned to receive chemotherapy as well. Patients were followed up to June 20, 1995, giving a median follow-up for 14 surviving patients of 5.4 years, range 0.3 to 10.2 years. Results: The clinical response rate to treatment was 77% [95% confidence interval (CT) 65 to 87%]. T he estimated median overall survival was 20.6 months (CI 12.4 to 33.4 months). On univariate analysis male gender, age <60 years, WHO perfor mance status less than or equal to 1, treatment to the target volume g reater than or equal to 45 Gy, and treatment with additional chemother apy, were associated with a significantly better overall survival (p < 0.05). On multivariate analysis only age and performance status remai ned significant prognostic variables. Relapse involved the central ner vous system or cerebrospinal fluid (CSF) in all patients with known si tes of relapse except three who had ocular relapse only. There was a l ow incidence of relapse in the initial brain site (23% of known cases) and a high incidence (50%) of CSF/spinal cord relapse. Of 48 deaths, 15 were related to initial or subsequent treatment. Conclusions: Patie nt outcome is strongly influenced by age and performance status. Studi es suggesting better survival for patients treated with chemoradiation may reflect patient selection rather than treatment variables. Optima l management remains to be defined. The high CSF/spinal relapse rate d eserves particular attention. (C) 1998 Elsevier Science Inc.