Ocular presentation of primary central nervous system lymphoma: diagnosis and treatment

Hormigo, Adı́lia; Abrey, Lauren E.; Heinemann, Murk-Hein; DeAngelis, Lisa M.

doi:10.1111/j.1365-2141.2004.05028.x

Cited by 139 publications

(103 citation statements)

References 34 publications

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“…In the three larger (n>10) series the outcome of IOL+ patients was comparable to that of IOL-and superior to that in the present study with median PFS of 18 months 2 and median OS of 20-31 months 2,7,18 . This cannot be explained by differences in patients` age or performance status between those analyses and the present study.…”

Section: Discussionsupporting

confidence: 60%

Prognostic impact of intraocular involvement in primary CNS lymphoma: experience from the G-PCNSL-SG1 trial

et al. 2014

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The impact of intraocular involvement (IOL) in primary CNS lymphoma (PCNSL) has not been sufficiently evaluated. Here, we present the analysis of IOL in the only completed randomized phase III trial in PCNSL. The G-PCNSL-SG1 study evaluated the role of whole-brain radiotherapy in primary therapy of PCNSL. Data of the 526 eligible study patients were checked, and clinical characteristics, therapy, and outcome of patients with IOL diagnosed at study inclusion were analyzed. Ophthalmologic examination at study inclusion was performed in 297 patients (56.5 %) of whom IOL was diagnosed in 19 (6.4 %). Clinical characteristics did not significantly differ between patients with IOL (IOL+) and those without (IOL-). The median progression-free survival (PFS) in the IOL+ group was 3.5 months (95 % CI 0.0-7.07) as compared to 8.3 months (95 % CI 4.78-11.78) in the IOL-group (P = 0.004), the median overall survival (OS) was 13.2 months (95 % CI 0.86-25.62) and 20.5 months (95 % CI 15.56-25.5), respectively (P = 0.155). In multivariate analysis, a significantly inferior PFS and OS for IOL+ patients were found. IOL at diagnosis of PCNSL was an independent negative prognostic indicator for PFS and OS in this analysis.

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Section: Discussionsupporting

confidence: 60%

Prognostic impact of intraocular involvement in primary CNS lymphoma: experience from the G-PCNSL-SG1 trial

et al. 2014

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“…However, available data are scarce and based only on retrospec- www.TheOncologist.com tive studies. In a single-center experience, Hormigo et al [121] suggested that patients whose ocular disease was identified and treated before CNS progression had a significantly longer survival time than those who were treated only after CNS disease was diagnosed. Treatment may be focal, including ocular RT and intraocular MTX chemotherapy, or extensive, including systemic chemotherapy and WBRT.…”

Section: Primary Intraocular Lymphomamentioning

confidence: 99%

Primary CNS Lymphoma in Immunocompetent Patients

et al. 2009

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Primary central nervous system lymphoma (PCNSL) constitutes a rare group of extranodal non-Hodgkin's lymphomas (NHLs), primarily of B cell origin, whose incidence has markedly increased in the last three decades. Immunodeficiency is the main risk factor, but the large majority of patients are immunocompetent. Recent evidence suggests a specific tumorigenesis that may explain their particular clinical behavior compared with systemic NHL. The addition of i.v. high-dose methotrexate (MTX) chemotherapy to whole-brain radiotherapy (WBRT) has considerably improved the prognosis, leading to a threefold longer median survival time compared with WBRT alone and represents the current standard of care. However, this combined treatment exposes the patient, especially the elderly, to a high risk for delayed neurotoxicity. In the older population (>60 years), there is growing evidence that MTX-based chemotherapy alone as initial treatment is the best approach to achieve effective tumor control without compromising patient quality of life. In the younger population, the risk for neurotoxicity is much lower, and this strategy is controversial because it may be associated with higher relapse rates. Future efforts should focus on the development of new polychemotherapy regimens allowing the reduction or deferral of WBRT in order to minimize the risk for delayed neurotoxicity. In this setting, intensive chemotherapy with autologous blood stem cell transplantation was recently demonstrated to be feasible and efficient as salvage therapy and is currently being evaluated as part of primary treatment. This review highlights the recent advances in the pathogenesis and treatment of PCNSL in the immunocompetent population.

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“…PIOL is a unique malignant lymphoproliferation because of its affectation of an immune privileged site, involving the subretinal pigment epithelium (RPE), retina, vitreous, and optic nerve. Frequently masquerading as a uveitis, PIOL is often misdiagnosed for intraocular inflammation and is treated with corticosteroids [5] or, infrequently, PIOL can masquerade as a viral retinitis and is treated with antiviral medication [6]. It is not until the presumed uveitis fails to respond to corticosteroid therapy that another cause is sought.…”

Section: Introductionmentioning

confidence: 99%