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Behera MK, Sharma A, Dutta S, Sharma S, Julka PK, Rath GK, Kil WJ, Ko C, Kaushal A, Warran K, Ning H, Camphausen K, Smart D, Vern-Gross TZ, McMullen KP, Case LD, Bourland JD, Ellis TL, Lawrence JA, Tatter SB, Shaw EG, Urbanic JJ, Chan MD, Jensen RL, Shrieve DC, Mohindra P, Robins HI, Tome WA, Howard SP, Chen C, Damek D, Gaspar LE, Ney D, Waziri A, Lillehei K, Kavanagh BD, Wang CC, Floyd S, Chang CH, Warnke P, Chio CC, Kasper E, Mahadevan A, Wong E, Jeyapalan S, Chen C, Mahajan A, Grosshans D, McAleer MF, Brown PD, Chintagumpala M, Vats T, Puduvalli V, Yock T, Schulder M, Herschmann Y, Ghaly M, Knisely J, Ghaly M, Kapur A, Schulder M, Knisely J, Goetz P, Lwu S, Ebinu J, Arayee M, Monsalves E, Laperriere N, Menard C, Bernstein M, Zadeh G, Loganathan AG, Chan MD, Alphonse N, Peiffer AM, Johnson A, McMullen KP, Urbanic JJ, Saconn PA, Bourland JD, Munley MT, Shaw EG, Tatter SB, Ellis TL, Lwu S, Goetz P, Aryaee M, Monsalves E, Laperriere N, Menard C, Bernstein M, Zadeh G, Mahajan A, Lowe C, McAleer MF, Grosshans D, DeGroot J, Mark G, Vats T, Brown PD, Ruda R, Trevisan E, Magliola U, Bertero L, Bosa C, Ricardi U, Soffietti R, Rajappa P, Margetis K, Wernicke AG, Sherr DL, Lavi E, Fine RL, Schwartz T, Pannullo SC, Laack N, Blanchard M, Buckner J, Glass J, Andrews DW, Werner-Wasik M, Evans J, Lawrence YR, Shi W, Strauss I, Corn BW, Matceyevsky D, Alani S, Gez E, Shtraus N, Kanner AA, Spasic M, Choy W, Nagasawa D, Yang I, Noel M, Woolf E, Smith R, Castillo-Rojas P, Sorenson S, Smith K, Scheck AC, Han SJ, Oh MC, Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, Parsa AT, Redmond KJ, Horska A, Ishaq O, Ford E, McNutt T, Batra S, Kleinberg L, Wharam M, Mahone M, Terezakis S, Ryu S, Rock J, Movsas B, Mikkelsen T, Rosenblum M, Sabsevitz D, Bovi JA, Leo P, LaViolette P, Rand S, Mueller W, Phillips A, Venkatramani R, Olch A, Grimm J, Davidson T, Brown R, Dhall G, Finlay J, Wong K. RADIATION THERAPY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Corn BW, Donahue BR, Rosenstock JG, Cooper JS, Xie Y, Brandon AH, Hegde HH, Sherr DL, Fisher SA, Berson A, Han H, Abdel-Wahab M, Koprowski CD, Ruffer JE, Curran WJ. Palliation of AIDS-related primary lymphoma of the brain: observations from a multi-institutional database. Int J Radiat Oncol Biol Phys 1997; 38:601-5. [PMID: 9231685 DOI: 10.1016/s0360-3016(97)89486-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To catalogue the presenting symptoms of patients with AIDS who are presumed to have primary central nervous system lymphoma (PCNSL). To document the palliative efficacy of cranial irradiation (RT) relative to the endpoints of complete and overall response for the respective symptoms. METHODS An analysis of 163 patients with AIDS-related PCNSL who were evaluated at nine urban hospitals was performed. These patients were treated for PCNSL after the establishment of a tissue diagnosis or on a presumptive basis after failing empiric treatment for toxoplasmosis. All patients were treated between 1983 and 1995 with radiotherapy (median dose-fractionation scheme = 3 Gy x 10) and steroids (>90% dexamethasone). Because multiple fractionation schemes were used, prescriptions were converted to biologically effective doses according to the formula, Gy10 = Total Dose x (1 + fractional dose/alpha-beta); using an alpha-beta value of 10. RESULTS The overall palliative response rate for the entire group was 53%. In univariate analysis, trends were present associating complete response rates with higher performance status (KPS > or = 70 vs. KPS < or = 60 = 17% vs. 5%), female gender (women vs. men = 29% vs. 8%), and the delivery of higher biologically effective doses (BED) of RT (Gy10 > 39 vs. < or = 39 = 20% vs. 5%). In multivariate analysis of factors predicting complete response, both higher KPS and higher BED retained independent significance. A separate univariate analysis identified high performance status (KPS > or = 70 vs. KPS < or = 60 = 71% vs. 47%), and young age (< or = 35 vs. > 35 = 61% vs. 40%) as factors significantly correlating with the endpoint of the overall response. In multivariate analysis, high performance status and the delivery of higher biologically effective doses of irradiation correlated significantly with higher overall response rates. CONCLUSION Most AIDS patients who develop symptoms from primary lymphoma of the brain can achieve some palliation from a management program that includes cranial irradiation. Young patients with excellent performance status are most likely to respond to treatment. The delivery of higher biologically effective doses of irradiation also may increase the probability of achieving a palliative response.
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Affiliation(s)
- B W Corn
- Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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Corn BW, Donahue BR, Rosenstock JG, Hyslop T, Brandon AH, Hegde HH, Cooper JS, Sherr DL, Fisher SA, Berson A, Han H, Abdel-Wahab M, Koprowski CD, Ruffer JE, Curran WJ. Performance status and age as independent predictors of survival among AIDS patients with primary CNS lymphoma: a multivariate analysis of a multi-institutional experience. Cancer J Sci Am 1997; 3:52-6. [PMID: 9072309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE There is limited information about the outcome of AIDS patients with primary central nervous system lymphoma treated with definitive irradiation. The purpose of this study was to determine factors associated with increased survival in such patients. METHODS An analysis was performed of 163 patients with AIDS who were evaluated at nine urban hospitals. These patients were treated for primary central nervous system lymphoma after the establishment of a tissue diagnosis or on a presumptive basis after failing empiric treatment for toxoplasmosis. All patients were treated between 1983 and 1995 with radiotherapy (median dose-fractionation scheme = 3 Gy x 10) and steroids (> 90% dexamethasone). Because multiple fractionation schemes were used, prescriptions were converted to biologically effective dose according to the formula Gy10 = Total Dose x (1 + fractional dose/alpha-beta), using an alpha-beta of 10. RESULTS Longer median survival times were associated with high Karnofsky performance status (KPS > or = 70 vs < or = 60: 181 vs 77 days), young age (< 35 vs > 35: 162 vs 61 days), and high total definitive irradiation doses (> 39 Gy10 vs < 39 Gy10: 162 vs 40 days). Tissue diagnosis, gender, race, number of lesions (solitary vs multiple), and the presence of other cancers did not influence outcome. In multivariate analysis, young age, high Karnofsky performance status, and the delivery of higher biologically effective doses of irradiation retained independent significance relative to the endpoint of survival. CONCLUSIONS Even at urban tertiary medical centers, few AIDS patients with intracranial lesions undergo biopsies to establish a precise tissue diagnosis. Survival following definitive irradiation is strongly related to two pretreatment factors (young age, high performance status) and one treatment factor (total biologically effective dose of cranial radiotherapy). These variables should be considered in selecting patients for definitive irradiation and in designing future studies.
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Affiliation(s)
- B W Corn
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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