Therapeutic management of primary central nervous system lymphoma in immunocompetent patients: Results of a critical review of the literature

Background: The optimal treatment for primary central nervous system lymphomas (PCNSL) has not yet been defined. Patients and methods: Therapeutic results of 1180 immunocompetent patients (pts) with PCNSL reported in 50 series published in English between 1980 and 1995 were analysed. The impact on survival of age, treatment strategy, radiation field and doses, systemic and intrathecal chemotherapy (CHT) and treatment sequence was evaluated. Results: Univariate analyses showed a longer survival in pts of less than or equal to 60 years (P < 0.00001); pts treated with > 40 Gy to whole brain (WB) (P = 0.02); pts receiving > 50 Gy to the tumor bed after a WB dose > 40 Gy (P = 0.02). pts submitted to a combined treatment as opposed to CHT alone (P = 0.007) or radiotherapy alone (P < 0.00001); pts receiving CHT followed by radiotherapy rather than in the reverse sequence (P = 0.05); pts treated with high-dose methotrexate (HD-MTX) (P = 0.04) and pts receiving intrathecal CHT (P = 0.03). Multivariate analysis confirmed the independent prognostic value of age, WE dose, HD-MTX and intrathecal CHT. Conclusions: Current data confirm the prognostic value of age and appear to support the use of systemic CHT consisting of HD-MTX and intrathecal drug administration followed by 41-50 Gy to WB and > 50 Gy to the tumor bed in the treatment of PCNSL in immunocompetent pts.