Radiation Therapy for Intracranial Lymphoma

Abstract

Although lymphoma is seen frequently in an active radiotherapy department, intracranial manifestations attributed to the disorder are rare (2). Histologic proof of such involvement is reported even less frequently. In one-third of the patients with clinical symptoms of intracranial lymphoma, no histologic evidence of involvement could be demonstrated at surgical exploration or postmortem examination (6, 7). In the absence of histologic confirmation, it is difficult to judge the effect of treatment or the course of the disease. Long-term survival in intracranial lymphoma has been considered nonexistent (5, 7). Recent evidence to the contrary led us to review the experience in the Division of Radiotherapy of the Columbia-Presbyterian Medical Center and New York Neurological Institute in an attempt to determine the course of disease more accurately. Present Experience Twenty-four histologically verified cases of intracranial lymphoma (lymphosarcoma, reticulum-cell sarcoma, mixed lympho-reticulum-cell sarcoma) were registered between Jan. 1, 1934, and Dec. 31, 1965. No case of Hodgkin's disease was encountered. Intra-axial structures were involved primarily in 21 cases. Extradural and meningeal involvement was present in 3. No histologic type showed a predilection for a specific anatomic location (Fig.1). We could not confirm the high relative incidence of temporal lobe involvement noted by others (4, 7). Rather, we found a predilection for the frontal and posterior fossa areas as reported by Kernohan and Uihlein (3). The age and sex incidences are shown in Figure 2. The sex ratio (male/female) is 11/13. All but 4 patients were between forty and sixty-nine years of age at the time of diagnosis. In 22 of the 24 signs and symptoms of intracranial involvement developed as the first manifestation of lymphoma. In 20, no disease was ever demonstrated outside the neuraxis. No symptom complex predominated. Persistent headache was the most common complaint (Table I). Laboratory results were of little aid in establishing the diagnosis. Skull roentgenograms were abnormal in 8 of 23 cases studied; displacement of a calcified pineal gland was present in 4 of these 8. Pneumoencephalography and ventriculography were frequently necessary to demonstrate a lesion. Arteriography was performed in 12 cases; an avascular mass was shown in all. The histologic diagnosis was made preopera-tively in 1 patient with evidence of generalized disease. All patients underwent surgical exploration with biopsy or subtotal tumor removal. Four died in the immediate postoperative period. The remaining 20 received irradiation directed to the tumor site, and its effectiveness could be judged in 18. Local control was not achieved in any of the 6 patients receiving a tumor dose of less than 3,000 R.