Primary intracerebral malignant lymphoma: report of 248 cases

Object. The authors present a retrospective analysis of 248 immunocompetent patients with primary intracerebral lymphoma treated at 19 French and Belg ian medical centers between January 1980 and December 1995. Methods. This study involved 127 female and 121 male patients with a median age of 61 years (range 2-88 years). All tumors available for review were c lassic diffuse non-Hodgkin's lymphoma, for which the phenotype was determin ed in 220 patients: 212 (96.4%) were B-cell and eight (3.6%) were T-cell ty pe tumors. According to the Revised European-American classification of lym phoid neoplasms, most lesions were diffuse large cell rumors (62%). A total of 196 turners were reviewed in 127 patients for whom preoperative compute rized tomography and magnetic resonance studies were available. There was a single lesion in 66% of the cases, with a supratentorial location in 87%. Tumor location in the basal ganglia, corpus callosum, or fornix, infiltrati on of the periventricular ependyma, or a mirror pattern, were strongly sugg estive of a lesion of lymphomatous origin. The histological diagnosis was o btained after surgical resection in 116 patients, with the remainder underg oing biopsy sampling only. Of the 248 patients studied, 129 (52%) received chemotherapy plus radiation therapy, 60 (24%) received radiation therapy al one, 35 (14%) received chemotherapy alone? and 24 (10%) received no postsur gical treatment. Conclusions. Using univariate analysis, the authors determined prognostic f actors that were significantly associated with a favorable impact on surviv al including age younger than 60 years, radiation therapy (without evidence of a dose-response relationship), radiation therapy combined with chemothe rapy, and chemotherapy consisting of anthracycline. Partial surgical resect ion was all unfavorable prognostic factor. Multivariate analysis was used t o confirm the independent prognostic value of radiation therapy, age, chemo therapy consisting of anthracyclines or methotrexate, and partial surgical resection. This European survey provides a reasonable basis for the treatme nt of primary intracerebral lymphoma with the following sequence: stereotac tic biopsy sampling, chemotherapy with a methotrexate- and anthracycline-ba sed regimen; followed by cranial irradiation.