Brain Lymphoma Treatment with Chemotherapy or Chemoradiotherapy from an Institution

Primary Brain Lymphoma (PBL) is an aggressive malignancy arising from the brain parenchyma. It is potentially curable brain tumor, or at least one in which durable remission can be achieved. We examined survival among patients with PBL treated with combination chemotherapy and radiotherapy and/or chemotherapy alone.

We conducted a retrospective study of 38 patient diagnosed with PBL and examined long-term survival and morbidity among patients treated with either combination chemotherapy and radiotherapy or chemotherapy alone between July 1, 2004 to July 1, 2012. Patients were eligible for the study if they were between 16 and 80 years of age, HIV negative and had positive pathology and immune- histochemical staining for non Hodgkin's lymphoma of the brain. All patients had CT scan of chest, abdomen and pelvic, total body bone scan and bone marrow aspiration as part of their initial work up.

Enrolled patients were treated with combination of chemotherapy and radiotherapy if they were younger than 60 and with chemotherapy only if they were older than 60 years to reduce cognitive complications related to radiotherapy in older adults. The chemotherapy regimen included Methotrexate 2500 mgs per M2 with Leucovorin rescue (started day two) and Vincristine 1.4 mg per m2 (day two) which was administered every other week for 6 weeks. Chemotherapy in younger patients (<60) was followed by daily radiotherapy for 3 weeks to a total of 4500 rads. Both groups received Cytarabine 3000 mgs per m2 for 2 successive days (3 weeks apart). Intrathecal injection of Methotrexate 15 to 20 mg plus Cytarabine 100 mg were given in all patients in whom spinal fluid was drown on suspicion of meningeal involvement.

Among the 38 patients 77 % had diffuse large B cell lymphoma and 56% presented with multiple lesions and 44% with a single lesion on MRI. The median age at diagnosis was 53 years (range19 to 75). Two thirds (65.7%) were men. Mean duration of follow-up was 12 months (range 1 to 100 months). Overall (21%) of all patients died from early relapse, 2 patients had disease outside of brain found after relapse one in the liver and another one in mediastinum. The vast majority of deaths were among patients younger than 60 (87.5%). Significant morbidity included memory loss, hemi paresis, blindness, abnormal gate, psychiatric problems and incontinence which persisted or developed in 30% of patients. Among all patients 50% are alive and without significant morbidity. Disease recurrence was noted in 30% of all patients. Relapsed patients have been treated indefinitely with high dose Methotrexate.

Current management of PBL either with chemotherapy alone and/ or combination chemotherapy and radiotherapy has improved long-term survival in these patients. The most troublesome complication of treatment has been memory loss.

No relevant conflicts of interest to declare.