Diagnosis and therapy of Hodgkin's disease in Freiburg in Breisgau 1964 to 1976. 1. Report of the complete collective

Between May 1964 and December 1976, 370 patients with Hodgkin's disease (CS/PSIn = 41 [11.2%], CS/PSIIn = 148 [40.2%], CS/PSIII n = 148 [40.2%], CS/PSIV n = 31 [8.4%] with different diagnoses were treated by different therapies, 250 out of them (67.5%) only by radiotherapy (local, extended, and total lymphoid irradiation), 115 (31%) by radiotherapy and chemotherapy, and five patients in stage IV (1.5%) only by chemotherapy. The first treatment divides the patients into three subgroups with significantly different prognoses: 1. a subgroup with complete remission assessed half a year after the end of therapy (n = 206 [58%]) and a healing rate of 96.2%; 2. a subgroup with partial remission (n = 62 [17.5%]) and a healing rate of 51.6%; 3. a subgroup without remission (n = 87 [24.5%]) and a healing rate of 4.2%. In case of recurrence after complete or partial remission, another complete and durable remission is achieved by subsequent therapy in about 85% of patients with preceding complete remission and statistically about 50% of patients with preceding partial remission. The overall five-year survival rate is 73.1%; a constant level of 67.3% (statistical healing rate) is observed after seven years. The following risk factors for remission have been found: the histologic manifestation lymphocytic depletion, parts of stage III, especially of type B, stage IV, and an age above 40 years and even more above 50 years.     

Peripheral soft tissue sarcomas. A retrospective study on 90 primary treatment patients

Between 1960 and 1982, 90 patients treated primarily for peripheral soft tissue sarcomas received a postoperative irradiation at the Irradiation Department of the St?dtische Krankenhaus Passau. Five patients (6%) were inoperable for internistic reasons and were treated only by radiotherapy. The local recurrence rate after combined therapy was 26%. 44% of the patients (40/90) developed metastases, preponderantly in the lung and within the first year (70% each). The age-corrected survival rate was 63% after five years and 43% after ten years in 79 patients with complete postoperative irradiation. Important prognostic factors are the degree of malignancy (five-year survival times of 57 patients: almost 90% for G1 tumors, 50% for G2 tumors, and 17% for G3 tumors, statistically significant) as well as the completeness of surgery. It is shown by the available results that conservative surgical interventions combined with radiotherapy are not less effective than more radical operations.     

Radiotherapy of cervix and uterus carcinomas (Marburg results of 1960 to 1975)

The authors present the therapy results and complications of 479 patients with carcinomas of the cervix and 241 patients with carcinomas of the body of the uterus. The five-year survival rate of the patients with carcinomas of the cervix is 57%. The first five years after diagnosis were survived by 79.6% of the patients in stage I, 57.3% of the patients in stage II, 31.1% of the patients in stage III, and 5.9% of the patients in stage IV. 60% of these patients were only submitted to percutaneous and intracavitary irradiation, and 40% were irradiated after operation. The five-year survival rate of the patients with carcinoma of the body was 74.3%. This rate was 80.8% in stage I, 77.5% in stage II, 57.5% in stage III, and 30% in stage IV. The operation frequency was relatively high with 74%, only 26% of these patients were only treated by radiotherapy. The percutaneous radiotherapy was performed exclusively under high voltage conditions, preponderantly according to the method of Marburg which allows a homogenous, small-field irradiation of the small pelvis with a dose until 45 Gy, but which deliberately does not expose to radiation the para-aortal lymph nodes. In the years of 1966 to 1971, a comparison with the method established in Düsseldorf was made. This method is working with two big U-shaped stationary fields including the para-aortal lymph nodes. The central part of the pelvis is collimated when percutaneous irradiation is applied, and the intracavitary treatment is applied with a higher dose, correspondingly. The present analysis of the treatment results of both methods does not show any significant difference as to the survival time. The incidence of fistulas, however, a severe late complication, which is 2.4% for the method of Marburg, is markedly lower than that of 8.6% for the other method. Prognostic factors and therapeutic aspects are discussed in detail.     

Retrospective analysis of nasopharyngeal carcinoma treated during 1976-1985: late complications following megavoltage irradiation.

A retrospective analysis was undertaken of the late complications observed in 4527 patients with nasopharyngeal carcinoma treated by megavoltage radiotherapy during the years 1976-1985. Unconventional fractionation schedules were used because of serious resource limitations. The median equivalent doses were 65 Gy to the nasopharyngeal region and 53 Gy to the cervical region. 707 patients had reirradiation for local recurrences and 250 for regional relapses. The 10-year actuarial cancer-specific survival was 47%, and the corresponding all-complication-free and neurological-complication-free rates were 40% and 72%, respectively. Altogether, 1395 (31%) patients developed one or more late irradiation sequelae. The majority were mild soft-tissue damages, but 322 (7%) had significant functional disturbances, from which 62 (1%) died. Neurological damage that occurred in 450 (10%) patients constituted the major morbidity and accounted for all but three of the treatment mortalities. The cumulative incidence of the various complications is summarized, and the data recorded in the literature reviewed in order to give a proper perspective of the problem. Patients treated during 1981-1985 had a significantly higher actuarial encephalomyelopathy-free rate than those treated during 1976-1980, but the incidence-free rates for the other neurological complications remained unimproved, suggesting that the improvement could be mainly attributed to additional shielding for the brainstem rather than the reduction of dose from 3.8-4.2 Gy to 2.5 Gy per fraction.     

Results of combined therapy of small cell bronchogenic carcinoma in a 5-year period (1984-1988)

Within the five-year period (1984-1988) the oat cell bronchogenic carcinoma was diagnosed and treated in 151 patients. Analysed were 74 patients having received complete treatment. Patients with disseminated form received only polychemotherapy in 6 cycles (cyclophosphamide, doxorubicin, vincristine and etoposide) and those with limited disease also received additional, local-regional radiotherapy of 45-50 Gy. In complete respondents preventive brain irradiation was applied. In selected patients with initial forms of the disease surgical resection with additional polychemotherapy were applied. The best survival showed respondents with limited disease and operated patients. Average survival of the whole group was 72 weeks. One year survived 31 out of 74 (41.9%) patients and two years survived 10 out of 74 (13.5%) patients.     

Results of radiation therapy in cervix carcinoma with reference to side effects

The analysis of 770 patients after irradiation of cervix-carcinoma from 1968 to 1976 with Cobalt 60, radium or operation or only irradiation therapy shows five-year survival rates of 78% for stage I, 61% for stage II, and 23% for stage III. Bowel reaction was seen in 27%, 4% developed stenoses, 1.3% a recto-vaginal fistula. A complication of the bladder was seen in 18%, 2.7% had an ureteral stricture and 0.8% a bladder-fistula.     

Astrocytoma in children. A review of 79 cases--1960-1976.

Seventy-nine children with histologically proven astrocytomas, 32 cerebral, 30 cerebellar, 9 thalamic, 6 optic nerve, and 2 in the 4th ventricular floor were reviewed retrospectively. Seventy-one per cent of the astrocytomas were well differentiated. Unlike adult astrocytomas, there was slight female predominance in our group. Cerebral astrocytomas were more frequent beyond nine years of age. The overall five-year survival rate of cerebral astrocytomas was 95% (19/20) for well-differentiated, and 19% (2/12) for poorly-differentiated tumors. In cerebellar astrocytomas the survival rates were 75% (18/24) and 33% (2/6) respectively.     

Radiotherapy for Stage I–III Nodal Low-Grade Non-Hodgkin’s Lymphoma

BACKGROUND: To evaluate retrospectively long-term results and patterns of recurrence in patients with low-grade non-Hodgkin's lymphoma (NHL) Ann Arbor stage I-II and limited stage III. PATIENTS AND METHODS: 58 patients, who had been treated between 1980 and 1996, were analyzed. Median follow-up period was 8.75 years. 48 patients (83%) presented with follicular lymphoma (stage I: 23 patients, stage II and III: 15 and ten patients, respectively). Median age was 51 years. Irradiation was applied with a median total dose of 40 Gy. 13 patients (22%) additionally received chemotherapy. End points of the investigation were remission rate, overall- and disease-free survival, and patterns of recurrence, as well as the prognostic impact of age, B-symptoms, chemotherapy, irradiation dose, treatment volume, and Ann Arbor stage. RESULTS: 6 weeks after treatment 91% of the patients had complete, 7% partial response. One patient (2%) was classified as progressive disease. Overall survival rate was 86% and 69% at 5 and 10 years, respectively. Corresponding disease-free survival rates were 73% and 63%. Regarding overall survival, multivariate analysis identified age (p = 0.001) as independent prognostic factor. In the subgroup of patients with follicular lymphoma 92% were found in complete, 6% in partial remission, one patient (2%) with progressive disease. Overall survival rates at 5 und 10 years were 87% and 70%, disease-free survival rates 75% and 64%, respectively. Out-of-field recurrence rate for all 58 patients was 34% and the proportion of relapses at nodal or lymphatic sites outside the treated areas in relation to all registered recurrences was 77%. CONCLUSIONS: Our results maintain external radiotherapy as a curative concept in the treatment of limited stage low-grade lymphoma, especially in younger patients. Patterns of recurrence would favor total nodal irradiation (TNI) as an appropriate approach for these patients.     

Exclusive radiotherapy of carcinoma of the hypopharynx. Retrospective study of a series of 100 patients

From January 1980 to December 1987, 100 patients with carcinoma of the hypopharynx, staged according to TNM (UICC-1978) criteria, received exclusive radiation therapy at the Radiotherapy Department of the General Hospital of Varese. The median follow-up is 9 months (range: 1-97). Irradiation was delivered with 60Co or with 10 MV photons and tissue-equivalent bolus. Two opposed parallel lateral fields or rotational technique were used, with progressive shrinking of treated volume in order to spare the spinal cord after 45 Gy. Direct fields of electron beams (6-15 MeV) were employed as boosts on the residual nodes. Median total doses: 64.5 Gy to T and N1-3, 45 Gy to N0. A conventional fractionation (2 Gy once a day, 5 times a week) was used in 37 outpatients, while an accelerated hyperfractionated regimen (1.5 Gy twice a day, 5 times a week, with a six hours' interval between each fraction) was employed in 63 inpatients, in order to shorten hospitalization. The five-year overall survival (Kaplan-Meier) of the 100 treated patients is 10%, while the five-year disease-free survival of the 40 patients in complete clinical remission at the end of radiation therapy is 19.8%. The five-year loco-regional control rate after exclusive radiotherapy is 19.1%. Complete remission at the end of treatment seems to represent the only significant prognostic variable affecting survival: five-year overall survival is 32% for the 40 patients achieving complete remission and only 4.4% for the others (p less than 0.05). On the contrary, tumor extension (T class) seems to affect only the two-year local control rate: 35.2% and 10.9% for T1 + T2 and T3 + T4 respectively (p less than 0.1). The main cause of failure after radiation therapy is represented by the lack of control at the primary site (T) alone or associated with regional adenopathies (N). The analysis of isoeffect parameters, according to CRE model, has not shown any evident dose-response relationship for local control. Late effects were observed in 7% of the patients and were similar to those reported in the literature. The occurrence of both distant metastases, 3% in our experience, and secondary tumors (9%) is lower than those previously reported. The present retrospective study strongly reconfirms the inadequacy of exclusive radiation therapy as the sole treatment modality for carcinoma of the hypopharynx and suggests the need of combination therapy (surgery and radiation) as primary treatment.(ABSTRACT TRUNCATED AT 400 WORDS)     

Radiotherapy of carcinoma of the prostate--5 years' experience

Forty three patients were treated for cancer of prostate by irradiation at the Radiotherapeutic Ward of the Research Institute of Clinical and Experimental Oncology in the years 1976 to 1981. The five-year period of survival in patients with a localized tumorous disease was 45%. The authors analyzed causes of unsuccessful therapy and evaluated complications of the therapy, the latter being mostly early postirradiation reactions. Possibilities of improving the results of treatment in optimizing the radiotherapy of the localized prostate cancer are outlined.     

Radiosensitivity test for cancer of the uterine cervix

In selecting the method of treating uterine cervical cancer, radiosensitivity is one of the most important factors. To know this factor before treatment, we are trying to estimate radiosensitivity with changes of primary tumors before and after the irradiation. Tumors must be irradiated uniformly with small doses, and based on these considerations, we are attempting external test irradiation for estimation of radiosensitivity. Radiosensitivity was determined histopathologically by comparing the results of histological specimens taken before and seven days after test irradiation. Radiosensitivity is closely related to prognosis: of 183 cases with good sensitivity, 146 cases (79.8%) were surviving at five years after radiotherapy. On the other hand, the five-year survival rate of cases with poor sensitivity was only 37.2%. Comparing radiation with operation in operable cases of stage I and II, the five-year survival rate in cases with good sensitivity was about the same (90%). On the contrary, in cases with poor sensitivity, there was a substantial difference: that is, 66.0% of operated cases had a five-year survival compared with 39.7% of radiated cases.     

Results of radiotherapy with cobalt 60 beads compared to surgery in 725 uterine neoplasms]

From 1958 to 1970, in 435 cases (60%) out of 725 carcinomas of the uterus sole radiation therapy by cobalt-60 beads was performed; in 288 cases (39.7%) surgery was done (combined with tele-cobalt-irradiation in almost all cases, 5000 to 6000 rd TD). Two cases (0.3%) received no treatment. The unfavorable selection of the irradiated women (average age 64,6 years) as against the surgically treated ones (average age 50.9 years) did allow a complete intracavitary irradiation only in 60.6% of the cases; in 39.4%, the dose had to be reduced considerably. The five-year survival amounted to: 64.4% after sole irradiation, 93.2% after operation/postirradiation in stage I; 46.9% after sole irradiation, 75.0% after operation/postirradiation in stage II; 30.8% after sole irradiation in stage III. No survivors existed in stage IV. Mortality from treatment with sole irradiation amounted to 1.8% (8/435). Radiation fistulas were observed after sole irradiation in 0.4% (1/435), after operation/postirradiation in 0.7% (2/288). As long as there is no satisfactory afterloading technique for intracavitary irradiation of the carcinoma of the uterus, an application of cobalt-60 beads seems to offer the following advantages as compared to an implant of radium filters: Shorter duration of the application, better adaptability to the cavitary lumen, diminished risk of perforation. No perforation was observed.     

Interstitial radiation in the treatment of carcinoma of the tonsillar region.

From 1964 to 1972, 69 patients were treated for carcinoma of the tonsillar region; all have been followed for at least 4 years. Sixteen patients (23%) had second primaries, and in 11 they were clearly the cause of death. No irradiated patient has died from primary recurrence after 2 years. The overall 3 year determinate survival rate (NED) for patients treated curatively was 63% (32/51). Twenty-four patients had interstitial implants after preliminary external radiation (usually 4,000 rad in 4 weeks). Local control (2+ years) was obtained in at least 82% (18/22); two clearly had recurrence. Of 12 stage I or II patients, 11 survived at least 2 years without evidence of disease; of 12 stage III or IV patients, seven did. Survival could have been improved by more aggressive management of neck nodes, as shown by results for the patients treated since 1969. While small superficial ulcers frequently occurred in the group with implants, all healed spontaneously in 1--6 months; there were no serious complications. The main advantages of implantation are reduction in serious complications and xerostomia.     

Role of radiotherapy in the treatment of seminoma of the testis

From 1965 through 1988, 113 patients affected with testicular seminoma were treated at the Dept. of Radiotherapy, University "La Sapienza", Rome, Italy. Mean age of the patients was 38 years; in 70 cases tumor developed in the right testis and in 43 in the left one. In 9 patients underlying cryptorchidism was observed. All cases underwent radical orchiectomy. Histology diagnosed anaplastic seminoma in 5 cases and pure seminoma in all the other patients. Structures were involved in 7 cases. Eighty-four patients were in stage I, 20 in stage IIA, 4 in IIB, 4 in IIIA, and 1 in stage IIIB. All patients staged as I and IIA were treated with exclusive radiotherapy on paraaortic lymph nodes and inguinal and iliac lymph nodes of the involved sites (total doses: 28-35 Gy in stage I and 34-40 Gy in stage IIA). Before 1970 these patients underwent prophylactic irradiation of mediastinum and of left supraclavicular lymph nodes (total dose: 25-28 Gy). Patients in stage IIB were administered subdiaphragmatic lymph nodes irradiation with inverted-Y field (total dose: 36-45 Gy). Two cases were irradiated also on mediastinum and left supraclavicular lymph nodes, and 2 received two cycles of polychemotherapy (PVB) before irradiation. Patients in stage IIIA underwent sub-/supra-diaphragmatic irradiation (total dose: 40-45 Gy, and 40-42 Gy). The case in stage IIIB underwent palliation chemotherapy and local irradiation. All cases in stages I, IIA and IIB obtained complete remission. Three cases of the 4 in stage IIIA obtained complete remission (75%), while 1 (25%) progressed and died 8 months after diagnosis; the only case in stage IIIB progressed and died after 7 months of follow-up. Two cases in stage I recurred (2.4%), 1 in the mediastinum and 1 in the left supraclavicular lymph nodes. Both were cured with salvage radiation therapy. Toxicity related to treatment was low. Two cases in stage I developed secondary malignant neoplasms, at 4 and 34 months of follow-up, respectively.     

Optimal thoracic irradiation for stage IV lung cancer

To investigate optimal thoracic irradiation (TI) for stage IV lung cancer, we retrospectively reviewed 150 patients. In all, 101 patients underwent radiotherapy for the primary lesion, and 130 had radiotherapy for metastasized sites. TI fields were basically divided into two groups; whole thoracic lesion irradiation (WTLI) and partial thoracic lesion irradiation (PTLI). Overall survival rates at 6 months, 1 year and 2 years were 58%, 27% and 11%, respectively, and MST was 7.1 months. There was no difference in survival according to histological type. On univariate analysis, the factors of good prognosis included good PS, free of bone metastasis, metastasis limited to a single organ, TI, chemotherapy, age (less than or equal to 75 years), and TN factors (T0-2 and N0-1). Multivariate analysis showed PS was the predominant factor. Among the patients treated with TI, survival rates of patients with PS 0-1 were superior to those of patients with PS 2-4. Radiation pneumonitis was more frequent in WTLI than in PTLI. The rates of thoracic failure death were 31.7% in patients treated with TI and 63.3% without TI. However, the size of the thoracic radiation field did not affect the rates of thoracic failure death. We concluded that TI for stage IV patients could reduce thoracic symptoms and increase the survival rate in the subgroup with good PS. Furthermore, we considered PTLI was worth while in the subgroup with poor PS.     

Combined treatment of hypopharyngeal carcinoma

From 1978 through 1984, 120 patients with hypopharyngeal carcinomas were treated cooperatively by the University Hospitals of Erlangen. 120 out of these patients were men and 6 women. 96 patients (80%) suffered from cervical lymph node metastases, 91 (76%) were already in UICC stage IV. There were two cases with stage I, eight cases (7%) with stage II, and 19 cases (16%) with stage III. Among the 116 patients treated by causal therapy, 70 (60%) reached complete remission (CR), 34 (29.5%) partial remission (PR), and 12 (10.5%) were non-responders (NC,P). The cumulative survival at five years was 14% in 120 patients and 24% in 70 patients after CR. None of the patients with PR or NC survived more than two years. 111 patients were irradiated. Group 1: radiotherapy alone (41 patients), group 2: surgery and radiotherapy (47 patients), group 3: chemotherapy and radiotherapy (19 patients). The medium treatment period was 76, 107, and 141 days, respectively. The cumulative survival at five years was 3% in group 1, 28% in group 2, the survival at three years in group 3 was 14%. The results of postoperative radiotherapy, amounting to 36%, were better than the rate of 20% achieved by preoperative radiotherapy and surgery. A survival at five years of 46% was obtained after transoral microlaryngoscopic laser resection and postoperative irradiation, which was therefore superior to conventional operation techniques combined with radiotherapy (16%). Moreover, better functional and cosmetic results were achieved with this method. The prognosis is unfavorably influenced by a high stage, lymph node manifestations, and dedifferentiated tumor histology.     

Radiotherapy of Hodgkin's disease in clinical stages I and II A: relapse of the disease and salvage therapy

The authors describe the results of 71 patients with clinical stage I A (40 patients) and II A (31 patients) primarily treated with radiotherapy alone (61 mantle fields and 10 subtotal-nodal plus spleen irradiation). All patients achieved complete remission at the end of the treatment; 31 (43.7%) patients (15 at stage I and 16 at stage II) relapsed during the follow-up, mostly for nodal or extranodal extensions (87% of relapses). In 21/31 relapsed patients chemotherapy +/- radiotherapy was utilized as salvage treatment. Three patients died for second solid tumors and 1 patient died for jatrogenic late effect (leukemia after 4 cycles of MOPP). Despite the high percent of relapses, the long term overall survival (83.4%) of these patients is quite satisfactory mostly for the efficacy of chemotherapy as salvage treatment. However the authors think that laparosplenectomy plus subtotal-nodal irradiation is the treatment of choice for patients with Hodgkin disease at stage I and II A. Chemotherapy, instead, must be primarily utilized only for patients with a worse prognosis for hilar adenopathies or "bulky" mediastinum.     

Risk factors associated with interstitial pneumonia following allogeneic bone marrow transplantation for acute leukemia in Japanese experience

Records of 101 patients with acute leukemia who received allogeneic bone marrow transplantation (BMT) with preparation using cyclophosphamide and total body irradiation (TBI) from September 1975 through July 1984 were collected into Japanese Bone Marrow Transplant Registry from 15 of the participating hospitals. These patients were divided into two groups by year of BMT. Group I included nine acute lymphocytic leukemia (ALL) and nine acute non-lymphocytic leukemia (ANL) patients who received BMT before 1980. Group II consisted 39 ALL and 44 ANL patients who were treated after 1981. One-year survivals were 11% and 58% in groups I and II, respectively (p less than 0.001). Probabilities of developing interstitial pneumonia at one year were 93% and 37% in groups I and II, respectively (p less than 0.001). Of 14 patients who developed interstitial pneumonia in group I, twelve (86%) died of interstitial pneumonia. Fifteen of 22 (68%) were fatal in group II. Using proportional hazard regression model, year of BMT (p = 0.0001) and selection of platelet donor with negative cytomegalovirus (CMV) titer (p = 0.0215) were found to be significant risk factors associated with interstitial pneumonia. The present analysis indicated that change in the selection of patients, e.g., in remission without infection at the time of BMT, as well as treatment modality, e.g., fractionated TBI, and selection of platelet donor with negative CMV titer, resulted in the significant improvement in the survival and decreased incidence of interstitial pneumonia.     

Curative and palliative radiotherapy of bladder cancer. A retrospective study of 11 years experience

A total of 119 patients with bladder cancer were irradiated over a period of 11 years. Fifteen had Stage B1, 15 B2, 38 C, 9 D1, 23 D2, and 19 D3. The pelvis, bladder, or both received less than or equal to 7,000 rad (70 Gy) in 7 weeks in 78 patients treated with curative intent (Group I) and less than or equal to 5,000 rad (50 Gy) in 5 weeks in 41 patients treated for palliation (Group II). Major complications developed in 3 patients due to irradiation and were fatal in 2, while 22 had minor, self-limited complications which were often related to the technique used. In Group I, the 3- and 5-year disease-free survival rates were 18% and 14%, respectively, whereas only 3% of Group II patients survived 3 years; however, reasonable palliation was achieved in a large percentage of cases. Superficial lesions (B1) can be cured with irradiation (60% 5-year survival). Other prognostic factors are presented.     

Results of primary central nervous system lymphoma treated by radiation and chemotherapy: retrospective analysis of twelve institutions in the Tokai District of Japan, 1995-1999

Purpose We analyzed the therapeutic results and prognostic factors of 46 primary central nervous system lymphoma (PCNSL) patients who were treated at twelve institutions in the Tokai district of Japan between 1995 and 1999. We compared the results with those of a Japanese nationwide survey performed in the past. Materials and Methods We sent each institution a questionnaire about the state of patients' disease, pathological type, method and doses of radiotherapy, regimen and intensity of chemotherapy, and patients' prognoses. The range of patients' ages was 33 to 93 years (median, 61 years). Thirty-one were men and 15 were women. The most prevalent histology was diffuse large B cell type (33 patients). We used the Kaplan-Meier method to calculate the survival rate and Cox's proportional hazards model to analyze the prognostic factors. Results The five-year cumulative survival rate was 25%, and the median survival time was 22.7 months. The five-year disease-free survival rate was 23%. In monovariate analysis, patients who were both younger than 60 years old and had a WHO performance status (PS) score equal to or less than 2 showed a better survival rate. Furthermore, the patients receiving systemic chemotherapy showed a significantly better local control rate. In addition, patients who received systemic chemotherapy achieved a higher complete remission rate than those not receiving it. However, no factors that significantly influenced survival rate were identified in multivariate analysis. Conclusion We demonstrated that the therapeutic outcome of PCNSL patients has recently improved. In particular, patients with good PS showed better local control than those with poor PS. However, we could not identify any significant prognostic factors in PCNSL patients.