Bw. Corn et al., PALLIATION OF AIDS-RELATED PRIMARY LYMPHOMA OF THE BRAIN - OBSERVATIONS FROM A MULTIINSTITUTIONAL DATABASE, International journal of radiation oncology, biology, physics, 38(3), 1997, pp. 601-605
Citations number
22
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To catalogue the presenting symptoms of patients with AIDS wh
o are presumed to have primary central nervous system lymphoma (PCNSL)
. To document the palliative efficacy of cranial irradiation (RT) rela
tive to the endpoints of complete and overall response for the respect
ive symptoms. Methods: An analysis of 163 patients with AIDS-related P
CNSL who were evaluated at nine urban hospitals was performed. These p
atients were treated for PCNSL after the establishment of a tissue dia
gnosis or on a presumptive basis after failing empiric treatment for t
oxoplasmosis. All patients were treated between 1983 and 1995 with rad
iotherapy (median dose-fractionation scheme = 3 Gy x 10) and steroids
(>90% dexamethasone). Because multiple fractionation schemes were used
, prescriptions were converted to biologically effective doses accordi
ng to the formula, Gy(10) = Total Dose x (1 + fractional dose/alpha-be
ta); using an (alpha-beta value of 10. Results: The overall palliative
response rate for the entire group was 53%. In univariate analysis, t
rends were present associating complete response rates with higher per
formance status (KPS greater than or equal to 70 vs. KPS less than or
equal to 60 = 17% vs. 5%), female gender (women vs. men = 29% vs. 8%),
and the delivery of higher biologically effective doses (BED) of RT (
Gy(10) > 39 vs. less than or equal to 39 = 20% vs. 5%). In multivariat
e analysis of factors predicting complete response, both higher KPS an
d higher BED retained independent significance. A separate univariate
analysis identified high performance status (KPS greater than or equal
to 70 vs, KPS less than or equal to 60 = 71% vs. 47%), and young age
(less than or equal to 35 vs. > 35 = 61% vs. 40%) as factors significa
ntly correlating with the endpoint of the overall response. In multiva
riate analysis, high performance status and the delivery of higher bio
logically effective doses of irradiation correlated significantly with
higher overall response rates. Conclusion: Most AIDS patients who dev
elop symptoms from primary lymphoma of the brain can achieve some pall
iation from a management program that includes cranial irradiation. Yo
ung patients with excellent performance status are most likely to resp
ond to treatment. The delivery of higher biologically effective doses
of irradiation also may increase the probability of achieving a pallia
tive response. (C) 1997 Elsevier Science Inc.