Radiation Therapy and High-Dose Corticosteroids in Treating Older Patients With Primary CNS Non-Hodgkin's Lymphoma

OBJECTIVES:

- Assess the effectiveness of high-dose dexamethasone after whole-brain radiotherapy in
maintaining response and preventing recurrence in elderly patients with primary central
nervous system non-Hodgkin's lymphoma.

- Assess the toxic effects of this regimen in these patients.

- Assess the survival rate of patients after this regimen.

- Identify the anatomic rates of recurrence and frequency of systemic involvement in
patients treated with this regimen.

- Identify the factors that appear to be associated with outcome in patients treated with
this regimen.

OUTLINE: Patients undergo whole-brain radiotherapy (WBRT) daily 5 days a week for 4.5 weeks.
Beginning 30 days after WBRT is completed, patients receive high-dose dexamethasone IV on
days 1-5 during course 1 and on day 1 only during all subsequent courses. Courses repeat
every 28 days in the absence of disease progression or unacceptable toxicity.

Patients are followed at 1 month after radiotherapy, every 3 months for 2 years, every 6
months for 3 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 28 patients will be accrued for this study within 6 years.

DISEASE CHARACTERISTICS:

- Pathologically confirmed non-Hodgkin's lymphoma with intracranial lesions

- Intraocular lymphoma eligible, if not sole site of disease

- No occult systemic lymphoma

- Measurable or evaluable disease by CT scan or MRI

- No neoplastic meningitis or gross spinal cord involvement

PATIENT CHARACTERISTICS:

Age:

- 70 and over

Performance status:

- ECOG 0-3

Other:

- No prior history of lymphoma

- No other active malignancy except basal cell skin cancer or carcinoma in situ of the
cervix

- HIV negative

- No active peptic ulcer disease

- No uncontrolled diabetes mellitus

- No active pancreatitis

- No active bleeding

- No poorly controlled major psychiatric illness

- No serious uncontrolled infection

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- No prior bone marrow transplantation

Chemotherapy:

- No prior chemotherapy

Radiotherapy:

- No prior radiotherapy to the brain or head and neck region

Surgery:

- No prior transplantations (renal, hepatic, or cardiac)