Primary cerebral lymphoma. A retrospective study of 27 cases

Primary cerebral lymphoma is a rare disease. The aim of this study is to compare the survival of the patients treated with radiotherapy alone vs. patients treated with a combined schedule of radio-chemotherapy. Our results will be compared with currently published data and main prognostic factors will be briefly discussed.

Between 1974 and 1990, 27 cases of primary cerebral lymphoma were diagnosed at our institution. All patients had biopsy-proven disease, the pathology of which was reviewed for this study.

The overall median survival time was 24 months and one-, two- and three-year overall survival was 59, 46 and 29% respectively. The median radiation dose was 46 Gy, ranging from 19.5 to 60 Gy. The median dose per fraction was 2 Gy (ranging from 1.61 to 3 Gy). The median elapsed treatment time was 32 days (ranging from three to 45 days). We were not able to demonstrate any statistically significant difference between patients who received radiotherapy alone (n = 14, median survival time = 24 months) and those who received a combination of chemotherapy and radiotherapy (n = 11, median survival time = 30 months), (p = 0.4). Prognostic factors of survival were tested using a univariate analysis (Wilcoxon test). Parameters such as mass appearance (unilobular, p = 0.048), performance status at the time of the diagnosis (0 to 1, p = 0.014), and CT imaging (hypodense, p = 0.043) influenced positively survival. Centroblastic histology (Kiel) was found associated with a negative prognosis (p = 0.043).

In our experience, there is no statistically significant difference of survival between patients treated with radiotherapy alone or with a combined treatment of radio-chemotherapy. Other prognostic factors of survival were discovered, although the analysis was univariate, due to the limited number of patients. Multicentric prospective studies should be elaborated in order to optimize the treatment of this disease.