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Combined-modality therapy in the treatment of primary central nervous system lymphoma in AIDS

Departments of Neurology (Drs. Forsyth and DeAngelis) and Radiation Oncology (Dr. Yahalom), Memorial Sloan-Kettering Cancer Center, and the Department of Neurology and Neuroscience (Drs. Forsyth and DeAngelis), Cornell University Medical College, New York, NY.

Purpose: Conventional therapy–ie, treatment with corticosteroids and cranial radiotherapy (RT)–is inadequate to treat AIDS-related primary central nervous system lymphoma (PCNSL), as it achieves a median survival of only 2 to 5 months. Chemotherapy added to RT in non-AIDS PCNSL improves disease control and prolongs survival. We studied the efficacy of this approach with RT in AIDS-related PCNSL.

Methods: Ten AIDS patients with PCNSL were treated with chemotherapy–nine at diagnosis and one at recurrence. None had evidence of systemic lymphoma. All patients treated at diagnosis received pre-RT methotrexate–eight also received thiotepa and procarbazine–followed by whole-brain RT. The patient treated at recurrence (who had been previously irradiated) received chemotherapy alone, including methotrexate, thiotepa, and procarbazine.

Results: All had enhancing lesions on MRI and five (50%) had a single lesion (seven [70%] had a ring-enhancing mass). No patient had a response to corticosteroids. Four of seven (57%) assessable patients had a partial or complete response to chemotherapy prior to RT. Six of seven (86%) assessable patients had a complete response at the end of treatment. Median survival was 3.5 months for all 10 patients and 7 months for the eight patients who completed therapy. Two patients survived for 1 year or longer. Eight patients died–six from infection (two treatment-related), one from progressive dementia, and one from a gastrointestinal hemorrhage.

Conclusion: AIDS-related PCNSL responds to chemotherapy and RT, but only a few patients benefit with prolonged survival.

Address correspondence and reprint requests to Dr. Lisa M. DeAngelis, 1275 York Avenue, New York, NY 10021.

Presented in part at the 45th annual meeting of the American Academy of Neurology, New York, NY, April 1993.

Received December 17, 1993. Accepted in final form February 7, 1994.

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