Primary central nervous system lymphoma: analysis of prognostic variables and patterns of treatment failure

The authors retrospectively analyzed the data on 36 patients with primary central nervous system (CNS) lymphoma. Most patients received radiation therapy to the whole brain with or without a boost. Chemotherapy was administered to six patients (18%) as part of their initial therapy. The 1- and 2- year rates of progression-free survival were 46% and 27%. The following factors had a favorable impact on survival: age of 60 years or less, normal or mildly impaired preirradiation neurologic function, and confinement of the tumor to the cerebral hemispheres or cerebellum. Chemotherapy as part of initial therapy appears to improve local control. Increasing radiation doses delayed local failure. Failure occurred in the brain (88%), in the eye (23%), and systemically (8%). There were no neuraxis failures identified. The authors conclude that primary CNS lymphoma is a locally aggressive disease that is poorly controlled with conventional radiation therapy. Investigation for more effective therapy is ongoing.