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Primary brain tumors in the acquired immunodeficiency syndrome

L M DeAngelis1

  • 1Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.

Current Opinion in Neurology
|December 1, 1995
PubMed

Insights

Primary central nervous system lymphoma is a common brain tumor in AIDS patients, often presenting as enhancing masses. While cranial irradiation offers temporary tumor regression, combining chemotherapy with radiotherapy may improve survival for some.

Area of Science:

  • Neuro-oncology
  • Infectious Diseases
  • Immunology

Background:

  • Primary central nervous system lymphoma (PCNSL) is the most frequent brain tumor in individuals with acquired immunodeficiency syndrome (AIDS), affecting approximately 10% of this population.
  • Clinical presentation often includes altered mental status and lateralizing neurological signs.
  • Radiological imaging (CT/MRI) typically reveals contrast-enhancing masses that are difficult to distinguish from other central nervous system (CNS) conditions like toxoplasmosis.

Purpose of the Study:

  • To summarize the diagnostic challenges and therapeutic outcomes for primary central nervous system lymphoma in patients with acquired immunodeficiency syndrome.

Main Methods:

  • Review of clinical presentations, diagnostic modalities, and treatment strategies for PCNSL in AIDS patients.
  • Discussion of diagnostic methods including brain biopsy and Epstein-Barr viral DNA detection in cerebrospinal fluid.
  • Analysis of treatment outcomes for cranial irradiation and combined chemotherapy-radiotherapy approaches.

Main Results:

  • Definitive diagnosis of PCNSL in AIDS patients often requires brain biopsy or detection of Epstein-Barr viral DNA in cerebrospinal fluid.
  • Cranial irradiation is a standard therapy, inducing tumor regression in most cases but resulting in short median survival (a few months).
  • Combining chemotherapy with radiotherapy shows promise, potentially extending survival to 1-2 years in a subset of patients.

Conclusions:

  • PCNSL in AIDS patients presents diagnostic and therapeutic challenges due to its similarity to other CNS infections.
  • While cranial irradiation provides symptomatic relief, novel therapeutic combinations are needed to improve long-term survival.
  • Chemotherapy combined with radiotherapy represents a potential advancement for select patients, offering improved survival outcomes.

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