Primary Diffuse Large B-Cell Lymphoma of Central Nervous System: Is Still Surgery an Unorthodox Treatment?

Siasios, Ioannis; Fotiadou, Aggeliki; Fotakopoulos, George; Ιωάννου, Μαρία; Anagnostopoulos, Vasileios; Fountas, Konstantinos

doi:10.14740/jocmr2376w

Cited by 7 publications

(7 citation statements)

References 43 publications

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“…Early results have shown their potential [ 23 , 24 ]. Even the role of surgery as an unorthodox treatment should be reconsidered [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Survival in Primary Central Nervous System Lymphoma: A Population-Based Study

Shan

2018

Disease Markers

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Objective This study sought to explore the prognostic factors in a large retrospective cohort of patients with primary central nervous system lymphoma (PCNSL) from the Surveillance, Epidemiology, and End Results database. Methods There were 5903 patients with PCNSL who had complete clinical information and were identified in the Surveillance, Epidemiology, and End Results program between 1973 and 2014. The epidemiology, therapeutic measures, and clinical characteristics were listed as descriptive statistics. They were grouped into 4 categories: immunocompetent individual with diffuse large B cell lymphoma (DLBCL), immunocompetent individual with non-DLBCL, immunocompromised individual with DLBCL, and immunocompromised individual with non-DLBCL based on different subtypes and immunological status. Survival analysis was conducted with Cox regression models. Results Different demographics and clinical characteristics were identified as independent factors in different groups. In survival analysis, for patients with DLBCL, chemotherapy involving treatments was associated with the most favorable survival. Received-only radiation could be considered as a primary treatment in immunocompetent patients with non-DLBCL. These differences were statistically significant (P < 0.05). Conclusion PCNSL patients treated with appropriate chemotherapy treatments may receive stable tumor control.

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“…Early results have shown their potential [ 23 , 24 ]. Even the role of surgery as an unorthodox treatment should be reconsidered [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and Survival in Primary Central Nervous System Lymphoma: A Population-Based Study

Shan

2018

Disease Markers

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“…While some investigations have proposed specific treatment algorithms [1], there is considerable debate concerning the standard of care for this disease [2–4]. …”

Section: Introductionmentioning

confidence: 99%

“…These technologies and practices have contributed to the safety of modern intracranial surgery [19]. In light of the new evidence suggesting a role for surgery in PCNSL treatment, some investigators have called for a reexamination of surgical resection for PCNSL [2–4], and some professional societies have recommended resection in certain circumstances [23]. Nevertheless, data on the complication rates following resection of PCNSL in the modern era are limited.…”

Section: Introductionmentioning

confidence: 99%

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

et al. 2017

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Object Surgical resection is not the standard of care for primary central nervous system lymphoma (PCNSL), as historical studies have demonstrated unfavorable complication rates and limited benefits. Some recent studies suggest that resection may provide a therapeutic benefit, yet the safety of these procedures has not been systematically investigated in the setting of modern neurosurgery. We examined the safety of surgical resection for PCNSL. Methods We retrospectively analyzed all patients with PCNSL treated at Columbia University Medical Center between 2000 and 2015 to assess complications rates following biopsy or resection using the Glioma Outcomes Project system. We identified predictors of complications and selection for resection. Well-validated scales were used to quantify patients’ baseline clinical characteristics, including functional status, comorbid disease burden, and cardiac risk. Results The overall complication rate was 17.2% after resection, and 28.2% after biopsy. Cardiac risk (p = 0.047, OR 1.72 [1.01, 2.95]), and comorbid diagnoses (p = 0.004, OR 3.05 [1.42, 6.57]) predicted complications on multivariable regression. Patients who underwent resection had better KPS scores (median 70 v. 80, p = 0.0068, Δ 10 [0.0, 10.00]), and were less likely to have multiple (46.5% v. 27.6%, p = 0.030, OR 1.42 [1.05, 1.92]) or deep lesions (70.4% v. 39.7%, p = 0.001, OR 1.83 [1.26, 2.65]). Age (p = 0.048, OR 0.75 per 10-year increase [0.56, 1.00]) and deep lesions (p = 0.003, OR 0.29 [0.13, 0.65]) influenced selection for resection on multivariable regression. Conclusions Surgical resection of PCNSL is safe for select patients, with complication rates comparable to rates for other intracranial neoplasms. Whether there is a clinical benefit to resection cannot be concluded.

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“…Moreover, resection carries no benefit in survival rates. Surgical resection should routinely be used only in cases of solitary lesions and in cases where intracranial pressure is increased [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebellar large B-cell lymphoma: a case report

et al. 2018

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BackgroundPrimary central nervous system lymphoma is a rare, malignant non-Hodgkin lymphoma that can arise in the brain, spinal cord, eye, leptomeninges, or cranial nerves. Primary central nervous system lymphoma is rare, accounting for 2–6% of all primary brain neoplasms and 1–2% of all non-Hodgkin lymphomas, and it usually presents as a solitary lesion. Cerebellar involvement is present in only 9% of cases. We present an unusual case of primary central nervous system lymphoma presenting as multiple lesions in the cerebellum in an immunocompetent host.Case presentationA 71-year-old Caucasian man presented to our hospital with acute onset of dizziness, nausea, vomiting, and gait imbalance. Contrast-enhanced computed tomography revealed three intensely enhancing masses in the right cerebellar hemisphere. Whole-body positron emission tomography and computed tomography failed to demonstrate a primary tumor of origin outside the central nervous system. The patient underwent right suboccipital craniotomy with partial resection of the visible tumor from the right cerebellum. Histopathology revealed diffuse large B-cell lymphoma, non-germinal center type.ConclusionsPrimary central nervous system lymphoma is rare, even more so in the cerebellum. However, the overall incidence of primary central nervous system lymphoma is rising in both immunocompromised and immunocompetent patients. The highly aggressive nature of primary central nervous system lymphoma necessitates timely diagnosis and intervention. In this report, we review the available literature for a better understanding of the pathophysiology and management of primary central nervous system lymphoma. To the best of our knowledge, this is the first reported case of a patient with primary central nervous system lymphoma presenting with multiple masses in the cerebellum.

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Primary Diffuse Large B-Cell Lymphoma of Central Nervous System: Is Still Surgery an Unorthodox Treatment?

Cited by 7 publications

References 43 publications

Prognostic Factors and Survival in Primary Central Nervous System Lymphoma: A Population-Based Study

Prognostic Factors and Survival in Primary Central Nervous System Lymphoma: A Population-Based Study

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

Cerebellar large B-cell lymphoma: a case report

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