Background and purpose: We report the results of a pilot study of the
use of accelerated radiation therapy for 10 patients with primary lymp
homa of the brain. Materials and methods: There were five females and
five males with a median age of 60 years (range 31-77 years) and a med
ian Karnofsky performance status of 60 (range 30-90). Nine patients un
derwent biopsies only and one patient underwent a partial resection. T
he radiation therapy consisted of 50 Gy in 25 fractions over 13 consec
utive days to the whole brain including all meningeal surfaces. Two fr
actions were delivered daily with a minimum interval of 6 h between fr
actions. Treatment was delivered daily right through the weekend with
no treatment interruptions. Results: To date nine patients have died.
The median survival was 17 months. Seven patients have demonstrated de
finite evidence of recurrence (six in the brain and one with positive
CSF cytology only). There have been two autopsies, one of which demons
trated diffusely recurrent tumor and the other showing residual diseas
e and radiation demyelination and small areas of necrosis in the pens
which undoubtedly was the cause of death at 5 months. One patient aliv
e and free of recurrence at 69 months has bilateral radiation retinopa
thy and an undiagnosed degenerative neurologic condition. Conclusion:
We conclude that this accelerated schedule of radiation therapy is ine
ffective in improving survival in primary lymphoma of the brain and is
associated with unacceptable increased toxicity. (C) 1998 Elsevier Sc
ience Ireland Ltd. All rights reserved.