Primary central nervous system lymphoma in acquired immune deficiency syndrome: A clinical and pathologic study with results of treatment with radiation

J. D. Goldstein, D. W. Dickson, F. G. Moser, Dennis W Dickson, K. Freeman, J. F. Llena, B. Kaplan, L. Davis

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Primary central nervous system (CNS) lymphoma occurs frequently in patients with the acquired immune deficiency syndrome (AIDS). Seventeen patients with AIDS and biopsy-proven CNS lymphoma were treated with whole-brain radiation. At presentation, most patients were severely debilitated from previous AIDS-related illnesses. Patients generally had focal neurologic symptoms such as seizures and paralysis. Headaches and mental status changes, often noticed after hospital admission, seldom brought our patients to seek medical attention. Computed tomography (CT) scan showed low-density, contrast-enhancing, mass lesions with variable amounts of peritumor edema. Size, location, and pattern of contrast enhancement of the lesions varied. No specific pattern was seen that could be used to distinguish between CNS lymphoma, toxoplasmosis, or other CNS diseases that occur in patients with AIDS. Biopsy results showed angiocentric, high-grade, large cell tumors with frequent necrosis. Immunohistochemical analysis showed B-cell phenotype with small amounts of T-cells, presumably reactive. All patients received irradiation to the whole brain with parallel opposed fields. A variety of doses and treatment regimens were used. Mean survival was only 72 days. Survival was longer in patients with higher pretreatment Karnofsky scores. The correlation between dose and survival was not significant. At completion of therapy, most patients showed improvement in Karnofsky score and had partial improvement in neurologic symptoms. CNS lymphomas in patients with AIDS are responsive to radiation. Posttreatment CT scans showed regression of tumors. Autopsy examinations showed regression of tumors, but also showed concurrent CNS infections, AIDS encephalopathy, and radiation-induced changes within the normal CNS tissue. Opportunistic infections rather than cerebral herniation or uncontrolled lymphoma was the most common cause of death.

Original languageEnglish (US)
Pages (from-to)2756-2765
Number of pages10
JournalCancer
Volume67
Issue number11
StatePublished - 1991
Externally publishedYes

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Lymphoma
Acquired Immunodeficiency Syndrome
Central Nervous System
Radiation
Therapeutics
Neurologic Manifestations
Survival
Cerebral Toxoplasmosis
Tomography
Clinical Studies
Biopsy
Nerve Tissue
Central Nervous System Infections
Neoplasms
Central Nervous System Diseases
Opportunistic Infections
Brain
Brain Diseases
Paralysis
Headache

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Goldstein, J. D., Dickson, D. W., Moser, F. G., Dickson, D. W., Freeman, K., Llena, J. F., ... Davis, L. (1991). Primary central nervous system lymphoma in acquired immune deficiency syndrome: A clinical and pathologic study with results of treatment with radiation. Cancer, 67(11), 2756-2765.

Primary central nervous system lymphoma in acquired immune deficiency syndrome : A clinical and pathologic study with results of treatment with radiation. / Goldstein, J. D.; Dickson, D. W.; Moser, F. G.; Dickson, Dennis W; Freeman, K.; Llena, J. F.; Kaplan, B.; Davis, L.

In: Cancer, Vol. 67, No. 11, 1991, p. 2756-2765.

Research output: Contribution to journalArticle

Goldstein, JD, Dickson, DW, Moser, FG, Dickson, DW, Freeman, K, Llena, JF, Kaplan, B & Davis, L 1991, 'Primary central nervous system lymphoma in acquired immune deficiency syndrome: A clinical and pathologic study with results of treatment with radiation', Cancer, vol. 67, no. 11, pp. 2756-2765.
Goldstein, J. D. ; Dickson, D. W. ; Moser, F. G. ; Dickson, Dennis W ; Freeman, K. ; Llena, J. F. ; Kaplan, B. ; Davis, L. / Primary central nervous system lymphoma in acquired immune deficiency syndrome : A clinical and pathologic study with results of treatment with radiation. In: Cancer. 1991 ; Vol. 67, No. 11. pp. 2756-2765.
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