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.