Document 0375
 DOCN  M9490375
 TI    Combined-modality therapy in the treatment of primary central nervous
       system lymphoma in AIDS.
 DT    9411
 AU    Forsyth PA; Yahalom J; DeAngelis LM; Department of Neurology, Memorial
       Sloan-Kettering Cancer Center,; New York, NY.
 SO    Neurology. 1994 Aug;44(8):1473-9. Unique Identifier : AIDSLINE
       MED/94336022
 AB    PURPOSE: Conventional therapy--ie, treatment with corticosteroids and
       cranial radiotherapy (RT)--is inadequate to treat AIDS-related primary
       central nervous system lymphoma (PCNSL), as it achieves a median
       survival of only 2 to 5 months. Chemotherapy added to RT in non-AIDS
       PCNSL improves disease control and prolongs survival. We studied the
       efficacy of this approach with RT in AIDS-related PCNSL. METHODS: Ten
       AIDS patients with PCNSL were treated with chemotherapy--nine at
       diagnosis and one at recurrence. None had evidence of systemic lymphoma.
       All patients treated at diagnosis received pre-RT methotrexate--eight
       also received thiotepa and procarbazine--followed by whole-brain RT. The
       patient treated at recurrence (who had been previously irradiated)
       received chemotherapy alone, including methotrexate, thiotepa, and
       procarbazine. RESULTS: All had enhancing lesions on MRI and five (50%)
       had a single lesion (seven [70%] had a ring-enhancing mass). No patient
       had a response to corticosteroids. Four of seven (57%) assessable
       patients had a partial or complete response to chemotherapy prior to RT.
       Six of seven (86%) assessable patients had a complete response at the
       end of treatment. Median survival was 3.5 months for all 10 patients and
       7 months for the eight patients who completed therapy. Two patients
       survived for 1 year or longer. Eight patients died--six from infection
       (two treatment-related), one from progressive dementia, and one from a
       gastrointestinal hemorrhage. CONCLUSION: AIDS-related PCNSL responds to
       chemotherapy and RT, but only a few patients benefit with prolonged
       survival.
 DE    Adult  Antineoplastic Agents/*THERAPEUTIC USE  Brain/PATHOLOGY  Central
       Nervous System Neoplasms/PHYSIOPATHOLOGY/*THERAPY  Combined Modality
       Therapy  Cranial Irradiation  Female  Human  Lymphoma,
       AIDS-Related/PHYSIOPATHOLOGY/*THERAPY  Magnetic Resonance Imaging  Male
       Middle Age  Neoplasm Recurrence, Local  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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