Primary brain lymphoma in immunocompetent patients-prognostic factors and treatment outcome

الملخص EN

Background : primary brain lymphoma (PBL) is an aggressive intracranial neoplasm of lymphocytic origin that involves the brain parenchyma and meninges.

The increasing number of cases of PBL has resulted in a growing awareness of and interest in this disease and has promoted a large number of publications.

Material and methods : Twenty-nine immunocompe-tent patients with primary non-Hodgkin's lymphoma of the brain (PBL) were seen at our institute between 1975 and 1998.

Twenty-seven patients had received external radiation therapy (XRT).

The treatment volume included the whole brain (WB) in 10 patients, WB plus boost in 12 patients and the craniospinal axis in 5 cases.

The XRT dose ranged from 5.4 to 60 Gy with a median of 50 Gy.

Two patients received pre-irradiation high dose methotrexate.

One patient received intrathecal methotrexate and one had 3 cycles of adjuvant chemotherapy.

Results: The mean age at diagnosis was 53 years.

Nine patients (31%) were found to have multifocal tumors.

Eighteen patients were evaluable for assessment of treatment response.

Complete response was achieved in 13 / 18 patients (72 %), while 4 (22 %) had partial response.

Six of 13 patients (46 %) who achieved complete response relapsed.

Late neurotoxicity was reported in 9 of 15 patients who survived for more than 6 months after therapy.

With a median follow up of 24 months, the 3 and 5-year overall survival (OS) rates were 40% and 16 %, respectively.

The median survival was 1.1 year.

Age < 60 years, performance status < 4, solitary brain lesion, XRT dose > 40 Gy, WB XRT with boost and complete response to therapy were found to be associated with statistically significant higher OS rates.

Cox regression analysis indicated that performance status, response to therapy and XRT dose > 40 Gy were the most significant prognostic variables.

Conclusion : the outlook with primary brain lympho-ma in immunocompetent patients remains somewhat dismal.

Randomized trials addressing the efficacy of chemotherapy (with and without radiation) over radiation alone are needed.

New treatment approaches need to be considered in a multiinstitutional setting.