Primary CNS lymphoma in immunocompetent patients from 1989 to 2001: a retrospective analysis of 164 cases uniformly diagnosed by stereotactic biopsy.
BACKGROUND
We present outcome data of a cohort of 164 immunocompetent PCNSL patients uniformly diagnosed at a single center for stereotactic neurosurgery, and evaluate the acceptance and impact of combination radiotherapy (RT) and chemotherapy (CHT) with high-dose methotrexate (HD-MTX) over time.


METHODS
We assessed choice of treatment and patient survival in a series of 164 PCNSL cases diagnosed from 1989 to 2001, and performed a re-evaluation of histopathology and pre-operative clinical data.


RESULTS
From 1989 to 1993, RT was the predominant therapy, and additional CHT did not improve survival. After 1994, the use of combination CHT/RT increased continuously, consistently contained MTX, and was associated with longer survival than RT only: median survival was 14 months after CHT/RT (2-year survival 35.7%) and 10 months (2-year survival 26.2%) after RT only (not significant). Overall median survival remained poor, increasing from six (1989-1993) to nine months (1994-2001) (p = 0.008). Survival was variable, with a few patients surviving >4 years after diagnosis in the CHT/RT as well as in the RT only group.


CONCLUSIONS
Despite considerable improvement of PCNSL therapy, the overall benefit of combined CHT/RT versus RT only was lower than that expected from previous phase II clinical trials. The striking variability of survival in either treatment group may suggest a yet undefined biological heterogeneity of PCNSL, which may also include a more aggressive PCNSL subtype in the group of patients with rapidly progressive disease and not eligible for standard therapy.
Feuerhake
F
F
Department of Neuropathology, University of Freiburg, Neurozentrum, Freiburg, Germany. friedrich_feuerhake@uniklinik-freiburg.de
Baumer
C
C
Cyron
D
D
Illerhaus
G
G
Olschewski
M
M
Tilgner
J
J
Ostertag
C B
CB
Volk
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D015331:Cohort Studies; D004358:Drug Therapy / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D008223:Lymphoma / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011878:Radiotherapy / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate