PALLIATION OF AIDS-RELATED PRIMARY LYMPHOMA OF THE BRAIN - OBSERVATIONS FROM A MULTIINSTITUTIONAL DATABASE

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.