Clinical analysis of 19 patients with primary cerebral lymphoma

Objective: To analyze the clinical features, treatment results and prognosis of primary cerebral lymphoma (PCL) and to investigate the improvement of treatment regimens. Methods: Nineteen patients with pathologically confirmed PCL were admitted from April, 1990 to August 2000, with a median age of 51 years, all without evidence of immuno-compromise. The tumor lesions manifested as solitary in 11 and multiple in 8 patients. Sixty-eight percent of tumor showed B lymphocyte origin, mainly with intermediate and high grade subtypes. Seventeen patients received radiotherapy after surgical resection, among them 10 also received chemotherapy. One patient received radiotherapy plus chemotherapy without surgery, one patient received radiotherapy alone. Results: The tumors responded well to the treatment, but the overall survival time were only 9-65 months (median 20 months). The 1-, 3-, and 5-year survival rates were 79.0%, 30.4% and 8.1%. Univariate analysis suggested that age of more than 60 years was a significant factor for poor prognosis (P=0.007), while the number of foci, radiation dose and use of chemotherapy had no significant effect on the survival. During the follow up, 86.7% (13/15) of patients had tumor relapse, all within the central nervous system, and 7 of them had uncontrolled or recurrent tumor at the original site, 6 of them were diagnosed as having cancerous ependymitis. Nervous system toxicity was the main complication. Conclusions: The incidence of primary cerebral lymphoma is increasing though with the treatment result disappointing. Prognosis of patients older than 60 years is poorer. Radiation dose escalation fails to give better control, while the advancement of combined modality treatment may improve the patients' survival