Extended survival with high quality of life in patients with primary intracerebral non-Hodgkin's lymphoma: report of four cases.

Abstract Between 1977 and 1993, we treated 47 patients with histologically verified primary intracerebral non-Hodgkin's lymphoma of B-cell origin. The cases of four of these patients (8.5% of the total) with long-term survival with high quality of life for more than 5 years are presented. Three have remained relapse-free for between 8.5 and 12 years after completion of original treatment; the fourth obtained complete remission for more than 5 years before death from tumor recurrence. All four patients were treated with our institutional therapeutic regimen, which includes radiotherapy consisting of 50–60 Gy to the tumor and 30–40 Gy to the whole brain, followed by four to six cycles of chemotherapy with cyclophosphamide, vincristine, adriamycin, and prednisolone at 4- and 8-week intervals. No further treatment was performed after remission had been obtained. No factors—including patient sex, age, tumor location, multiplicity of lesions, histology, or treatment modality—proved to be specific predictors of therapeutic success. The administration of chemotherapy beginning at the conclusion of radiotherapy in order to enhance the radiation antitumor effect may, however, have contributed to therapeutic success. The finding that all four patients had an immediate response to radiation may be related to their relatively high rate of survival. Histologic examination disclosed small non-cleaved cell lymphoma (high-grade malignancy) in one patient; diffuse large cell lymphoma (intermediate malignancy) in two patients; and small lymphocytic lymphoma (low-grade malignancy) in one patient. Posttherapeutic management during follow-up observation is discussed.