Purpose. To report the clinical experience with external beam radiotherapy (RT) for AIDS-related lymphoma (ARL) with or without the involvement of the central nervous system (CNS) in HIV-infected patients. Patients and Methods. Clinical outcome of 24 HIV-seropositive patients with ARL treated with RT from 1995 to 2004 was reviewed, testing factors associated with outcome. Results. After 1 and 5 years, the overall survival was 65% and 35%, respectively. The mean RT dose was 31 Gy after normalization to fractions of daily 2 Gy (range, 7.8-47.2 Gy). Radiotherapy dose was associated with survival in univariate (P = .04) and multivariate analysis (P = .01). Other factors in univariate analysis associated with outcome were viral load (VL), highly active antiretroviral therapy (HAART), ARL stage, and CNS involvement. Patients with CNS involvement achieved complete response in 46% and improved clinical performance was seen in 73%. Conclusions. After chemotherapy, RT in combination with HAART is highly active, and RT should be encouraged especially after suboptimal responses to induction treatment.
Ledergerber B., Telenti A., Egger M.Risk of HIV related Kaposi's sarcoma and non-Hodgkin's lymphoma with potent antiretroviral therapy: prospective cohort study. Swiss HIV Cohort Study. BMJ. 1999;319(7102):23-24.
2.
Friedman-Kien AE, Laubenstein LJ, Rubinstein P., et al. Disseminated Kaposi's sarcoma in homosexual men. Ann Intern Med. 1982;96(6 pt 1):693-700.
3.
Hymes KB, Cheung T., Greene JB, et al. Kaposi's sarcoma in homosexual men-a report of eight cases. Lancet. 1981;2(8247):598-600.
4.
Update on acquired immune deficiency syndrome (AIDS)-United States. MMWR Morb Mortal Wkly Rep. 1982;31(37):507-508, 513-514.
5.
Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome.Council of State and Territorial Epidemiologists, AIDS Program, Center for Infectious Diseases . MMWR Morb Mortal Wkly Rep. 1987;36(suppl 1):1S-15S.
6.
Hysterectomy prevalence and death rates for cervical cancer-United States, 1965-1988. MMWR Morb Mortal Wkly Rep. 1992;41(2):17-20.
7.
Lyter DW, Bryant J., Thackeray R., Rinaldo CR, Kingsley LAIncidence of human immunodeficiency virus-related and nonrelated malignancies in a large cohort of homosexual men. J Clin Oncol. 1995;13(10):2540-2546.
8.
Kirk O., Pedersen C., Cozzi-Lepri A., et al. Non-Hodgkin lymphoma in HIV-infected patients in the era of highly active antiretroviral therapy. Blood. 2001;98(12): 3406-3412.
9.
Aboulafia DM, Pantanowitz L., Dezube BJAIDS-related non-Hodgkin lymphoma: still a problem in the era of HAART. AIDS Read. 2004;14(11):605-617.
10.
Levine AM, Seneviratne L., Espina BM, et al. Evolving characteristics of AIDS-related lymphoma. Blood. 2000;96(13):4084-4090.
11.
Knowles DM, Chamulak GA, Subar M., et al. Lymphoid neoplasia associated with the acquired immunodeficiency syndrome (AIDS). The New York University Medical Center experience with 105 patients (1981-1986). Ann Intern Med. 1988 ;108(5):744-753.
12.
Sparano JAClinical aspects and management of AIDS-related lymphoma. Eur J Cancer. 2001;37(10): 1296-1305.
13.
Knowles DMEtiology and pathogenesis of AIDS-related non-Hodgkin's lymphoma. Hematol Oncol Clin North Am. 2003;17(3):785-820.
14.
Besson C., Goubar A., Gabarre J., et al. Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy. Blood. 2001;98(8):2339-2344.
15.
Goldstein JD , Dickson DW, Moser FG, et al. Primary central nervous system lymphoma in acquired immune deficiency syndrome. A clinical and pathologic study with results of treatment with radiation. Cancer. 1991; 67(11):2756-2765.
16.
Cheung MC, Pantanowitz L., Dezube BJAIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy. Oncologist. 2005;10(6):412-426.
17.
Oehler-Janne C., Seifert B., Lutolf UM, Ciernik IFLocal tumor control and toxicity in HIV-associated anal carcinoma treated with radiotherapy in the era of antiretroviral therapy . Radiat Oncol. 2006;1(29):1-9.
18.
Edelman S., Johnstone PACombined modality therapy for HIV-infected patients with squamous cell carcinoma of the anus: outcomes and toxicities. Int J Radiat Oncol Biol Phys. 2006;66(1):206-211.
19.
Harris NL, Jaffe ES, Diebold J., et al. The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Report of the Clinical Advisory Committee meeting, Airlie House , Virginia, November, 1997. Ann Oncol. 1999;10(12):1419-1432.
20.
Carbone PP, Kaplan HS, Musshoff K., et al. Report of the Committee on Hodgkin's Disease Staging Classification . Cancer Res. 1971;31(11):1860-1861.
21.
Therasse P. , Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000 ;92(3):205-216.
22.
Lukawska J. , Cottrill C., Bower M.The changing role of radiotherapy in AIDS-related malignancies. Clin Oncol (R Coll Radiol). 2003;15(1):2-6.
23.
Copaceanu ML , Coucke PA, Cottin E., Paschoud N., Mirimanoff ROAzidothymidine (AZT) as a potential modifier of radiation response in vitro. Acta Oncol. 1995;34(2):213-218.
24.
Maggiorella L., Wen B., Frascogna V., Opolon P., Bourhis J., Deutsch E.Combined radiation sensitizing and anti-angiogenic effects of ionizing radiation and the protease inhibitor ritonavir in a head and neck carcinoma model. Anticancer Res. 2005;25(6B): 4357-4362.
25.
Newell ME, Hoy JF, Cooper SG, et al. Human immunodeficiency virus-related primary central nervous system lymphoma: factors influencing survival in 111 patients. Cancer. 2004;100(12):2627-2636.
26.
Ratner L., Lee J., Tang S., et al. Chemotherapy for human immunodeficiency virus-associated non-Hodgkin's lymphoma in combination with highly active antiretroviral therapy. J Clin Oncol. 2001;19(8):2171-2178.
27.
Vaccher E., Spina M., di Gennaro G., et al. Concomitant cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy plus highly active antiretroviral therapy in patients with human immunodeficiency virus-related, non-Hodgkin lymphoma. Cancer. 2001; 91(1):155-163.
28.
Sparano JA, Lee S., Chen MG, et al. Phase II trial of infusional cyclophosphamide, doxorubicin, and etoposide in patients with HIV-associated non-Hodgkin's lymphoma: an Eastern Cooperative Oncology Group Trial (E1494). J Clin Oncol. 2004;22(8): 1491-1500.
29.
Kaplan LD, Lee JY, Ambinder RF, et al. Rituximab does not improve clinical outcome in a randomized phase 3 trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin lymphoma: AIDS-Malignancies Consortium Trial 010. Blood. 2005; 106(5):1538-1543.
30.
Mounier N., Spina M., Gabarre J., et al. AIDS-related non-Hodgkin lymphoma: final analysis of 485 patients treated with risk-adapted intensive chemotherapy. Blood. 2006;107(10):3832-3840.
31.
Hoffmann C. , Wolf E., Fatkenheuer G., et al. Response to highly active antiretroviral therapy strongly predicts outcome in patients with AIDS-related lymphoma. AIDS. 2003;17(10):1521-1529.
32.
Hoffmann C. , Tabrizian S., Wolf E., et al. Survival of AIDS patients with primary central nervous system lymphoma is dramatically improved by HAART-induced immune recovery. AIDS. 2001;15(16):2119-2127.
33.
Skiest DJ, Crosby C.Survival is prolonged by highly active antiretroviral therapy in AIDS patients with primary central nervous system lymphoma. AIDS. 2003; 17(12):1787-1793.
34.
Fine HA, Mayer RJPrimary central nervous system lymphoma. Ann Intern Med. 1993;119(11):1093-1104.
35.
Baumgartner JE, Rachlin JR, Beckstead JH, et al. Primary central nervous system lymphomas: natural history and response to radiation therapy in 55 patients with acquired immunodeficiency syndrome. J Neurosurg. 1990 ;73(2):206-211.
36.
Corn BW, Donahue BR, Rosenstock JG, et al. 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(1):52-56.
37.
Mocroft A., Katlama C., Johnson AM, et al. AIDS across Europe, 1994-98: the EuroSIDA study. Lancet. 2000; 356(9226):291-296.
38.
Ives NJ, Gazzard BG, Easterbrook PJThe changing pattern of AIDS-defining illnesses with the introduction of highly active antiretroviral therapy (HAART) in a London clinic. J Infect. 2001;42(2):134-139.
39.
Eltom MA, Jemal A., Mbulaiteye SM, Devesa SS, Biggar RJTrends in Kaposi's sarcoma and non-Hodgkin's lymphoma incidence in the United States from 1973 through 1998. J Natl Cancer Inst. 2002;94(16):1204-1210.
40.
Grulich AE, Li Y., McDonald AM, Law MG, Kaldor JMDecreasing rates of Kaposi's sarcoma and non-Hodgkin's lymphoma in the era of potent combination antiretroviral therapy. AIDS. 2001;15(5):629-633.
41.
Wilde JT, Lee CA, Darby SC, et al. The incidence of lymphoma in the UK haemophilia population between 1978 and 1999. AIDS. 2002;16(13):1803-1807.
42.
Scadden DTAIDS-related malignancies. Annu Rev Med. 2003 ;54:285-303.
43.
Bonnet F., Lewden C., May T., et al. Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy . Cancer. 2004;101(2):317-324.
44.
Louie JK, Hsu LC, Osmond DH, Katz MH, Schwarcz SKTrends in causes of death among persons with acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy, San Francisco, 1994-1998 . J Infect Dis. 2002;186(7):1023-1027.
45.
Antinori A. , Cingolani A., Alba L., et al. Better response to chemotherapy and prolonged survival in AIDS-related lymphomas responding to highly active antiretroviral therapy. AIDS. 2001;15(12):1483-1491.
46.
Lascaux AS, Hemery F., Goujard C., et al. Beneficial effect of highly active antiretroviral therapy on the prognosis of AIDS-related systemic non-Hodgkin lymphomas. AIDS Res Hum Retroviruses. 2005;21(3):214-220.
