Abstract
INTRODUCTION: Brain lymphoma is known to be more common in immuno-compromised patients. There have been no phase III trials comparing treatment. The literature implies that chemotherapy is the treatment of choice, but in practice many patients do not receive this, or any treatment. We aimed to determine the outlook for such patients treated at Royal Preston Hospital. METHOD: A retrospective review of casenotes of patients treated by one clinician (AH) over a 13 year period obtained from neuropathology and radiotherapy databases. Kaplan-Myer survival curves were generated using SPSS software. RESULTS: 40 Patients were studied. The following symptoms were recorded at presentation;- confusion in 40%, headache in 28%, falls in 22%, weakness in 18%, visual problems in 12%, memory loss in 10%, incontinence in 10%, dysphasia in 8%, impotence in 2%. 35% had multifocal disease, 5% had vitreous involvement and 7% did not undergo biopsy. 38% of patients received radiotherapy alone. 32% received primary chemotherapy, median survivals were 11.5 and 18 months respectively. Untreated patients (30%) had a median survival of 1.5 months. Patients who received radiotherapy alone had a mean age of 69 and a mean WHO score of 1.9;- those who received chemotherapy had a mean age of 53 years and a mean WHO score of 0.9. 31% of patients died during chemotherapy. 54% of patients who had radiotherapy exhibited symptoms of neurotoxicity. 61% of these patients were over 60 years old. CONCLUSION: Primary brain lymphoma is rapidly fatal if untreated. Chemotherapy +/- radiotherapy produces the best survival, but often leads to toxicity which may be fatal. Radiotherapy alone produces long survival but at the cost of neurotoxicity.