Results of empiric radiotherapy for hiv associated primary CNS lymphomas

The incidence of primary CNS lymphomas has been projected to increase to that of meninqiomas by 1991, largely because of the' frequency of-AIDS-related cases. Consequently, appropriate diagnosis will become a common task. It will also be a difficult task because of Ill the infectious etiologies that look identical on CT/MRI, (2) the possibility of co-existent infection and tumor and (3)-the potential morbidity of brain biopsy. These factors have led us to abandon diagnosis by biopsy and adopt a policy of selection of therapy on an empiric basis. From 1983 through 1988, 20 AIDS victims, ranging in age from 25 to 56 years (average 38 years) were treated with radiation therapy for CNS lymphoma. The patients tended to be in poor general condition: 80% had Karnofsky scores 160. Diagnosis was established as follows: 3 patients had biopsy proof; 4 had "classic" CT/MRI findings of lymphoma and 12 had received therapy for toxoplasmosis either without improvement (1) or with deterioration (11). A variety of dose fractionation schemes and volumes (see Table) were used.