Clinical experiences in 17 cases of radiotherapy of primary brain malignant lymphoma. Is solo-local field therapy supported with chemotherapy warranted?

Merits over demerits of combining chemotherapy (CT) and radiotherapy for primary brain malignant lymphoma (PBML) has recently been emphasized. In our institution solo-local brain irradiation (LB) supported with chemotherapy has been performed on four patients to avoid therapeutic brain damage. Results in radiotherapy in 17 patients with PBML from 1987 to 1995 were retrospectively analyzed. 16 patients completed the radiation schedule with consisting of 45.9±6.5 Gy. Among the 16 patients three were treated with whole brain irradiation (WB) nine with WBLB and the four LB. Complete disappearance (CR) was obtained in 81.3%. Early death occurred in 4 out of 5 patients with non-telencephalic, i.e., mid brain pontine and ventricular based lesions. Overall MST was 25.5 months. Disease free survival (DFS) was better in WB + WBLB group than LB (p<0.05). Averaged relapsing time was 24.8 month in WB + WBLB and 8.2 in LB. No statistical differences were found in survival rate between WB (+) and WB (-) and in DFS between CT (+) and CT (-). Activity index was improved in 7 but worsened in 4 patients after radiotherapy. In conclusion solo-local brain irradiation supported with chemotherapy did not show any merit than whole brain based therapy. (author)