Combined high-dosage polychemotherapy as efficient single therapy of primary cerebral lymphomas

The incidence of primary CNS lymphomas is steadily increasing. A curative therapeutic regimen could not yet be established. Radiotherapy is palliative only with a mean survival of 12 to 18 months after diagnosis. A combination of whole brain irradiation and chemotherapy may increase mean survival up to four years; however, late neurotoxic sequelae are severe and affect about half of the surviving patients. We report on eight patients (mean age 57 ys) who were treated with combined intraventricular/ systemic chemotherapy only, based on a high-dosage MTX- and Ara-C regimen. Seven of the eight patients showed complete tumour remission after therapy; in one case treatment-related toxicity led to death of a 71-year old man. The mean recurrence-free interval is more than 15 months already, and six patients continue to be in complete remission. in one patient, the tumour recurred after 22 months, and showed complete remission again after administration of chemotherapy alone. Therapy-related neurotoxicity was not observed, and it is discussed whether chemotherapy alone should be the treatment of first choice in this tumour type.