scholarly journals SURG-30. SURGICAL RESECTION OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA: IMPACT OF PATIENT SELECTION ON OVERALL SURVIVAL

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii209-ii210
Author(s):  
Nadav Schellekes ◽  
Arianna Barbotti ◽  
Yael Abramov ◽  
Razi Sitt ◽  
Francesco Di Meco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Surgical Resection ◽  
Median Survival ◽  
Needle Biopsy ◽  
Central Nervous System Lymphoma ◽  
Prolonged Survival ◽  
Solitary Lesion ◽  
Superficial Tumor

Abstract OBJECTIVE A possible prolonged survival after surgical resection for primary central nervous system lymphoma (PCNSL) lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established. METHODS We retrospectively searched our patient database for records of adult patients (≥18 years) who were diagnosed and treated for a solitary lesion of PCNSL between 2005 and 2019. Patients were divided into groups according to whether they underwent surgical resection or needle biopsy. Statistical analyses were performed in an attempt to identify variables affecting outcome and possible survival advantage and to characterize subgroups of patients who would benefit from resection of their tumor compared to undergoing biopsy only. RESULTS 113 patients with a solitary lesion of PCNSL were identified, 36 underwent surgical resection and 77 a diagnostic stereotaxic biopsy only. Pre-operative risk factors were found to include age > 70 years ([HR] 9.61, 95% [CI] 2.42-38.11, p=0.001) and deep seated lesions (adjusted HR 3.33, 95% CI 1.13-9.84, p=0.030). Having a postoperative Karnofsky Performance Scale (KPS) under 80 (adjusted HR 3.21, 95% CI 1.05-9.77, p=0.040) or surgical-site infections (adjusted HR 4.27, 95% CI 1.18-15.47, p=0.027) were significant postoperative risk factors. In a subgroup analysis, patients with a superficial tumor who underwent surgical resection had significantly longer survival times compared with those who underwent needle biopsy (median survival 34.3 months versus 8.9 months, p=0.014). Patients under 70 years who had a superficial tumor and underwent surgical resection had significantly prolonged survival, with a median survival of 35.0 months versus 8.9 months in patients from the same group who underwent needle biopsy (p=0.007). CONCLUSION Specific subgroups of patients with a solitary PCNSL lesion might gain a survival benefit from surgical resection compared to undergoing only a diagnostic biopsy.

Resection of primary central nervous system lymphoma: impact of patient selection on overall survival

2021 ◽  
pp. 1-10
Author(s):  
Nadav Schellekes ◽  
Arianna Barbotti ◽  
Yael Abramov ◽  
Razi Sitt ◽  
Francesco Di Meco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Median Survival ◽  
Needle Biopsy ◽  
Central Nervous System Lymphoma ◽  
Prolonged Survival ◽  
Karnofsky Performance Scale ◽  
High Dose ◽  
Superficial Tumor

OBJECTIVEPrimary central nervous system lymphoma (PCNSL) is a rare CNS tumor with a poor prognosis. It is usually diagnosed by needle biopsy and treated mainly with high-dose chemotherapy. Resection is currently not considered a standard treatment option. A possible prolonged survival after resection of PCNSL lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established.METHODSThe authors retrospectively searched their patient database for records of adult patients (≥ 18 years) who were diagnosed and treated for a solitary PCNSL between 2005 and 2019. Patients were divided into groups according to whether they underwent resection or needle biopsy. Statistical analyses were performed in an attempt to identify variables affecting outcome and possible survival advantage and to characterize subgroups of patients who would benefit from resection of their tumor compared with undergoing biopsy only.RESULTSA total of 113 patients with a solitary lesion of PCNSL were identified; 36 patients underwent resection, and 77 had a diagnostic stereotactic biopsy only. The statically significant preoperative risk factors included age ≥ 70 years (adjusted HR 9.61, 95% CI 2.42–38.11; p = 0.001), deep-seated lesions (adjusted HR 3.33, 95% CI 1.13–9.84; p = 0.030), and occipital location (adjusted HR 4.26, 95% CI 1.08–16.78; p = 0.039). Having a postoperative Karnofsky Performance Scale (KPS) score < 80 (adjusted HR 3.21, 95% CI 1.05–9.77; p = 0.040) and surgical site infection (adjusted HR 4.27, 95% CI 1.18–15.47; p = 0.027) were significant postoperative risk factors after the adjustment and selection by means of other possible risk factors. In a subgroup analysis, patients younger than 70 years who underwent resection had a nonsignificant trend toward longer survival than those who underwent needle biopsy (median survival 35.0 months vs 15.2 months, p = 0.149). However, patients with a superficial tumor who underwent resection had significantly longer survival times than those who underwent needle biopsy (median survival 34.3 months vs 8.9 months, p = 0.014). Patients younger than 70 years who had a superficial tumor and underwent resection had significantly prolonged survival, with a median survival of 35.0 months compared with 8.9 months in patients from the same group who underwent needle biopsy (p = 0.007).CONCLUSIONSSpecific subgroups of patients with a solitary PCNSL lesion might gain a survival benefit from resection compared with undergoing only a diagnostic biopsy.

Risk Factors for Early Mortality in Patients with Primary Central Nervous System Lymphoma: A Large-Cohort Retrospective Study

2020 ◽  
Vol 138 ◽  
pp. e905-e912
Author(s):  
Xingwang Zhou ◽  
Xiaodong Niu ◽  
Junhong Li ◽  
Shuxin Zhang ◽  
Wanchun Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Central Nervous System Lymphoma ◽  
Early Mortality ◽  
Large Cohort

Risk factors for intraocular involvement in patients with primary central nervous system lymphoma

2014 ◽  
Vol 120 (3) ◽  
pp. 523-529 ◽  
Author(s):  
Bum-Joo Cho ◽  
Hyeong Gon Yu
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma

scholarly journals Multi-modality Therapy Leads to Longer Survival in Primary Central Nervous System Lymphoma Patients

2002 ◽  
Vol 29 (2) ◽  
pp. 147-153 ◽  
Author(s):  
Dhruv Singhal ◽  
Timothy F. Witham ◽  
Anand Germanwala ◽  
John C. Flickinger ◽  
David Schiff ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Median Survival ◽  
Survival Data ◽  
Cox Regression ◽  
Central Nervous System Lymphoma ◽  
Treatment Modalities ◽  
Cox Regression Analysis ◽  
Single Modality

Abstract:Background:Primary central nervous system lymphoma (PCL) is more frequently encountered by neurosurgeons given the increasing incidence among both nonimmunocompromised and immunocompromised patients. The most frequent surgery is stereotactic biopsy. Historically, radiation therapy has been the standard treatment modality for this disease and median survival was in the 15-month range. More recently, multi-modality therapy combining radiation therapy with chemotherapy (systemic, intrathecal, and/or intra-arterial) have resulted in longer survivals. We reviewed survival data for our series of patients treated for PCL over the last decade.Methods:Thirty-four patients with histologically confirmed PCL were treated at our center. Multivariate Cox regression analysis was performed to determine which factor(s) (age, gender, HIV status, Karnofsky Performance Scale, chemotherapy, single modality therapy, histology, location, number of lesions, surgical resection) had a significant impact on survival.Results:The overall median survival was 19 months. Patients receiving multi-modality therapy (n=17) (chemotherapy and radiation) had a median survival of 34 months compared to four months for patients receiving single modality therapy (n=17 including seven HIV positive patients). Multi-modality therapy was the only significant factor affecting survival in this multivariate analysis (p<0.0001).Conclusions:Chemotherapy plus radiotherapy significantly enhances survival over patients treated with single modality therapy alone. Quality of life issues should be addressed on a case by case basis as additional treatment modalities are initiated.

High Dose-Chemotherapy Followed By Autologous Peripheral Blood Stem Cell Transplantation for Patients with Refractory or Recurrent Primary Central Nervous System Lymphoma –Results of a Multicenter Study By the Germany Collaborative PCNSL Study Group

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2527-2527
Author(s):  
Gerald Illerhaus ◽  
Kristina Fritsch ◽  
Ingo Schmidt-Wolf ◽  
Roland Schroers ◽  
Gerlinde Egerer ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Median Survival ◽  
Central Nervous System Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Intent To Treat ◽  
Treat Population

Abstract Introduction: Primary central nervous system lymphoma (PCNSL) relapses in up to 60% after conventional chemotherapy. The prognosis of refractory or recurrent PCNSL is very poor with a median survival of up to 5 months. Whole brain radiotherapy may improve survival up to 10 months, but is associated with significant neurotoxicity. High-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) have demonstrated high efficacy in the treatment of newly-diagnosed primary CNS lymphoma (PCNSL) in younger patients (pts.). To evaluate the efficacy of this approach, we initiated a prospective multicenter phase II study with HDT and ASCT for relapsed PCNSL. This trial is registered at ClinicalTrials.gov (NCT 00647049) Patients and Methods: Thirty eight pts. <65 years were treated within the phase II trial, chemotherapy (CHT) consisted of 2 cycles of Rituximab (3,75mg/m²), AraC (2x 3 g/m2) plus thiotepa (TT, 40 mg/m2) followed by rG-CSF and stem-cell-mobilization after the 1st cycle. Conditioning regimen included BCNU (400 mg/m2) and TT (4x5 mg/kgBW) followed by ASCT. Patients not in complete remission after HDT and ASCT underwent WBRT. Results: From 2007 to 2012, 38 pts (18 female, 20 male) with relapsed (n=31) or refractory (n=7) PCNSL from 10 German centers were enrolled and evaluable for analysis (median age 58 years, range 37-66 years). All pts had aggressive B-cell lymphomas (DLBCL). Median Karnofsky performance status at diagnosis was 90% (range 60-100). Patients were intensively pretreated, all pts underwent HD-MTX within the first-line-treatment, 15 of 38 pts were treated within the Bonn protocol. Thirty-one of 38 pts (81,6%) received HDT and ASCT according to protocol. Three pts died before PBSCT, 4 further pts were treated off study due to PD (n=2), refusal of HDT (n=1) and insufficient stem cell harvest (n=1). Regarding the primary endpoint in the intent-to-treat population, 22 pts (57,9%) achieved complete (CR) and and 5 (13,2%) partial remission (PR) after HDT and ASCT, respectively. In patients treated per protocol, the CR and PR-rate rate was 71% and 16,1% respecticely. The overall respinse rate in the per protocol population was 86,1%. Six pts in PR after HDT and ASCT received consolidating WBRT. After a median 39-month follow-up (range 0-48 mo), 1 and 2 years OS was 63% and 57%, respectively. Median survival of the intent-to-treat population was 29 months. Further results will be presented. Conclusion: Sequential systemic application of high-dose cytostatic agents followed by HDT+ASCT is highly effective as salvage therapy for pts. with relapsed or refractory PCNSL. Disclosures Illerhaus: Riemser: Honoraria. Wolf:Bayer: Honoraria; Geo Pharma: Honoraria. Stilgenbauer:Pharmacyclics, Janssen: Honoraria, Research Funding.

scholarly journals ML-09 The REAL-WORLD of Elderly PCNSL Therapy in Tohoku and Niigata Area According to Retrospective Analysis: A Collaborative Investigation of the Tohoku Brain Tumor Study Group

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii17-ii17
Author(s):  
Kenichiro Asano ◽  
Yoji Yamashita ◽  
Takahiro Ono ◽  
Manabu Natsumeda ◽  
Takaaki Beppu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Real World ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Central Nervous System Lymphoma ◽  
Rank Test ◽  
Cox Regression Analysis ◽  
The Real

Abstract Introduction: Recently, the number of cases of primary central nervous system lymphoma in elderly patients(EL-PCNSL) has been increasing. However, the treatment may be insufficient because of poor performance status and pre- and posttreatment complications. Therefore, we analyzed the risk factors for EL-PCNSL in the Tohoku and Niigata areas of Japan and clarified the REAL-WORLD of EL-PCNSL therapy. Materials & Methods: We investigated surgical and nonsurgical cases of patients aged 71 years or older from eight facilities during the last 8 years. We analyzed patient information, radiotherapy/chemotherapy or not, PFS, OS, RRs, second-line therapy, pre- and posttreatment complications, outcomes, and risk factors for poor prognosis. The log-rank test was used for univariate analysis, and Cox regression analysis was used for a multivariate analysis of risk factors. Results: Of the 142 cases registered, five differed from PCNSL pathologically, three receiving BSC were excluded, 31 were treated without biopsy, three were treated based on CSF-findings, and 100 were treated with biopsy. Total 134 cases were followed. The median age was 76 years, pretreatment KPS was 50%, and 118 cases(88%) had 217 pretreatment complications. The treatment contents consisted of various combinations depending on the attending physician. The retrospective overall PFS was 16 months and OS was 24 months. In the early treatment phase, out of 16 cases with dropout, four tumor and four complication deaths occurred. There were 77 deaths(58%), 39 internal tumor deaths(51%), and 33 complication deaths(43%). Poor prognostic risk factors were &lt;60% posttreatment KPS, complications involving pretreatment cardiovascular and central nervous system disease, posttreatment pneumonia or severe infection, and absence of radiation or chemotherapy. Conclusions: Pretreatment KPS did not affect poor outcomes, but posttreatment KPS &lt;60% and pre- and posttreatment complications did. Radiotherapy and chemotherapy are reportedly effective, but additional research to clarify the details of these modalities is needed.

Diagnosis and Treatment of the Primary Central Nervous System Lymphoma in The Riga Eastern Clinical University Hospital

2013 ◽  
Vol 13 (1) ◽  
pp. 39-44
Author(s):  
Aleksejs Repnikovs ◽  
Daina Apskalne
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Combination Therapy ◽  
Median Survival ◽  
Full Range ◽  
Central Nervous System Lymphoma ◽  
B Cell Lymphoma ◽  
University Hospital ◽  
The Past ◽  
Immunocompetent Patients

Summary Introduction. Primary central nervous system lymphoma (PCNSL) is a rare tumor. It is diagnosed in 1-3% of all primary malignant tumors of the CNS. However its incidence increased over the past ten years amongst the immunesupressed and also the immunocompetent patients. PCNSL incidence amongst neurooncology patients is increasing in Latvia as well, therefore it is important to draw more attention to this problem. Aim of the study. Research and analyse the experience of the Riga Eastern Clinical University hospital (RECUH) in the management of the patients with PCNSL over the last 11 years (from 2001 till 2012). In this research the data about the incidence of the disease, the connection between the age and sex, as well as the diagnostic and therapeutic possibilities are discussed. Materials and methods. This is a retrospective descriptive study. In this study were included all the patients with morphologically confirmed PCNSL (n=18) that were operated in the neurosurgical clinic in the 11-year time period (from 2001 till 2012). The statistical analysis of the data was made by means of the Microsoft Excel 2010 and SPSS 20th version of the descriptive statistical methods. Results. Over 11 years (from 2001 till 2012) PCNSL was confirmed in 18 patients, 17 (94.44%) of which were immunocompetent and in 1 patient (5.56%) HIV C1 stadium was diagnosed. Amongst immunocompetent patients 47.06% (n=8) were male and 52.94% (n=9) were female in the age between 45 and 79 years with average age of 64.41 years. Most often PCNSL was diagnosed in the age group between 65 and 69 years. 83.33% of all the PCNSL cases were diagnosed beginning with 2007. In all of the PCNSL patients a B-cell-lymphoma was morphologically confirmed. By admission the average Karnofsky Performance Scale Index was 57.78 in all patients, but after receiving a combination of therapy it was 77.78. The median survival amongst all of the patients was 515 days or 17 month, but amongst the patients, that received the full range combination therapy, the median survival achieved 867 days or 29 month. Conclusions. The analysed data demonstrates that the incidence of PCNSL has mighty increased over the past six years and PCNSL is more often diagnosed in elderly, in which the KPS index and the median survival considerably increases after the combination therapy.

scholarly journals Changing Incidence and Survival of Primary Central Nervous System Lymphoma in Australia: A 33-Year National Population-Based Study

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 403
Author(s):  
Alexandra L. Farrall ◽  
Justine R. Smith
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Confidence Interval ◽  
Median Survival ◽  
Survival Probability ◽  
Central Nervous System Lymphoma ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Incidence Rates ◽  
Cns Lymphoma

Primary central nervous system lymphoma (PCNSL) is a rare brain cancer that remains challenging to study. Epidemiology of PCNSL in the Australian population, which is racially and ethnically diverse, has not been examined previously. Using ICD-O-3.1 Morphology and Topography Codes to identify cases, we analyzed complete datasets from the comprehensive Australian Cancer Database (1982–2014, adults aged ≥ 20 years) to establish incidence rates and trends of PCNSL, and to define survival outcomes of individuals diagnosed with PCNSL, including the predominant diffuse large B-cell lymphoma (DLBCL) type. Age-standardized incidence of PCNSL increased by an average annual 6.8% percent over the study period, with current incidence of 0.43 (95% confidence interval, 0.41–0.46) per 100,000 person-years, in comparison to 21.89 (21.41–22.38) per 100,000 person-years for non-CNS lymphoma. Increase in incidence was characterized by an acute rise between 1996 and 1999, was more pronounced with increasing age, and was driven by increasing incidence of DLBCL. Overall survival for persons diagnosed with PCNSL improved significantly across the study period, with 5-year survival probability increasing from 0.21 (95% confidence interval, 0.16–0.26) to 0.33 (0.30–0.36), and median survival increasing from 318 to 600 days, between 1982–1999 and 2000–2014. Increase in survival was significantly higher for persons with DLBCL versus non-DLBCL PCNSL, but substantially lower than that for persons with non-CNS lymphoma, who had a 5-year survival probability of 0.62 (0.62–0.62) and a median survival of 3388 days in 2000–2014. This study links increasing incidence of PCNSL in Australia to increasing incidence of DLCBL, including in younger adults, and highlights the improving, but low, survival outcome of this cancer.

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