The role of surgical resection in primary central nervous system lymphoma: a single-center retrospective analysis of 70 patients

Abstract Background The aim of this study was to evaluate the effect of surgical resection and stereotactic biopsy on the complication rate, progression-free survival (PFS) and overall survival (OS) of 70 patients diagnosed at a single institution with primary central nervous system lymphoma (PCNSL) and to explore the predictors of selection for resection and the prognostic factors of PCNSL. Methods A retrospective analysis was performed of 70 patients with PCNSL that was diagnosed by surgical resection or stereotactic brain biopsy in our department from January 2013 to May 2019. We divided the patients into two groups: a resection group (n = 28) and a stereotactic biopsy group (n = 42). Data on clinical characteristics, imaging findings, complication rates, PFS and OS were retrospectively reviewed and compared between these two groups. We also analysed the predictors of selection for resection and prognostic factors of PCNSL by multivariate analysis. Results The median age was 53.3 ± 14.3 years, and there was a male predominance with a sex ratio of 1.33:1. The most common clinical manifestation was a headache. The complication rate in the resection group was 10.7% versus 7.1% in the stereotactic biopsy group, and there was no statistically significant difference. The rate of improvement in symptoms of the resection group was significantly higher than that of the stereotactic biopsy group. Multivariable analysis identified a single tumour and not involving deep structures as predictors of selection for resection. With a median follow-up of 30 months (range 1–110), the mean OS and PFS of all patients were 16.1 months and 6.2 months, respectively. Patients who underwent surgical resection had a mean OS of 23.4 months and PFS of 8.6 months versus 11.2 months and 4.6 months for those who had a brain biopsy performed. In addition, multivariable analysis showed that not involving deep structures and resection were favourable prognostic factors for PCNSL. Conclusions The outcomes of patients with PCNSL treated in our cohort are still poor. In our series, surgical resection might play a role in significantly improving OS and PFS compared with stereotactic biopsy in a subset of patients. The type of surgery and tumour location are prognostic factors for PCNSL.

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Patients with Primary Central Nervous System Lymphoma Not Eligible for Clinical Trials: Prognostic Factors, Treatment and Outcome

Cancers ◽

10.3390/cancers13122934 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2934

Author(s):

Sabine Seidel ◽

Michelle Margold ◽

Thomas Kowalski ◽

Alexander Baraniskin ◽

Roland Schroers ◽

...

Keyword(s):

Central Nervous System ◽

Clinical Trials ◽

Nervous System ◽

Prognostic Factors ◽

Central Nervous System Lymphoma ◽

Initial Response ◽

Early Response ◽

Multicenter Trial ◽

High Dose ◽

Therapeutic Trials

Patients with primary central nervous system lymphoma (PCNSL) not fulfilling inclusion criteria for clinical trials represent an underreported population. Thirty-four consecutive PCNSL patients seen at our center between 2005 and 2019 with exclusion criteria for therapeutic trials were analyzed (non-study patients) and compared with patients from the G-PCNSL-SG-1 (German PCNSL Study Group 1) study (study patients), the largest prospective multicenter trial on PCNSL, comprising 551 patients. Median follow up was 68 months (range 1–141) in non-study patients and 51 months (1–105) in study patients. Twenty-seven/34 (79.4%) non-study patients received high dose methotrexate (HDMTX), while seven/34 (20.6%) with a glomerular filtration rate (GFR) < 50 mL/min did not. Median overall survival (OS) was six months (95% confidence interval [CI] 0–21 months) in those 34 non-study patients. The 27 non-study patients treated with HDMTX were compared with 526/551 G-PCNSL-SG-1 study patients who had received HDMTX as well. Median OS was 20 months (95% CI 0–45)/21 months (95% CI 18–25) in 27 non-study/526 study patients (p = 0.766). Favorable prognostic factors in non-study patients were young age, application of HDMTX and early response on magnet resonance imaging (MRI). If HDMTX-based chemotherapy can be applied, long-term disease control is possible even in patients not qualifying for clinical trials. Initial response on early MRI might be useful for decision on treatment continuation.

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Clinical Characteristics, Surgical Outcomes, and Prognostic Factors of Intracranial Primary Central Nervous System Lymphoma

World Neurosurgery ◽

10.1016/j.wneu.2020.04.049 ◽

2020 ◽

Vol 139 ◽

pp. e508-e516

Author(s):

Taohui Ouyang ◽

Long Wang ◽

Na Zhang ◽

Zongyong Zhang ◽

Yifeng Xiong ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Prognostic Factors ◽

Surgical Outcomes ◽

Clinical Characteristics ◽

Central Nervous System Lymphoma

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Central nervous system lymphoma: Patterns of incidence in Indian population and effect of steroids on stereotactic biopsy yield

Neurology India ◽

10.4103/0028-3886.137033 ◽

2014 ◽

Vol 62 (3) ◽

pp. 343

Author(s):

SunilKumar Raina

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Indian Population ◽

Stereotactic Biopsy ◽

Central Nervous System Lymphoma

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Outcome and prognostic factors of primary central nervous system lymphoma in Southern Thailand

Asian Journal of Neurosurgery ◽

10.4103/ajns.ajns_208_20 ◽

2020 ◽

Vol 15 (3) ◽

pp. 560

Author(s):

Anukoon Kaewborisutsakul ◽

Thanya Sopittapan ◽

Thara Tunthanathip

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Prognostic Factors ◽

Central Nervous System Lymphoma ◽

Southern Thailand

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Diagnosis of primary central nervous system lymphoma: a systematic review of the utility of CSF screening and the role of early brain biopsy

Neuro-Oncology Practice ◽

10.1093/nop/npz015 ◽

2019 ◽

Vol 6 (6) ◽

pp. 415-423 ◽

Cited By ~ 1

Author(s):

Alexis A Morell ◽

Ashish H Shah ◽

Claudio Cavallo ◽

Daniel G Eichberg ◽

Christopher A Sarkiss ◽

...

Keyword(s):

Systematic Review ◽

Central Nervous System ◽

Nervous System ◽

Diagnostic Yield ◽

Diagnostic Delay ◽

Central Nervous System Lymphoma ◽

Brain Biopsy ◽

Suspected Case ◽

Stereotactic Brain Biopsy

Abstract Background Because less-invasive techniques can obviate the need for brain biopsy in the diagnosis of primary central nervous system lymphoma (PCNSL), it is common practice to wait for a thorough initial work-up, which may delay treatment. We conducted a systematic review and reviewed our own series of patients to define the role of LP and early brain biopsy in the diagnosis of PCNSL. Methods Our study was divided into 2 main sections: 1) systematic review assessing the sensitivity of cerebrospinal fluid (CSF) analysis on the diagnosis of PCNSL, and 2) a retrospective, single-center patient series assessing the diagnostic accuracy and safety of early biopsy in immunocompetent PCNSL patients treated at our institution from 2012 to 2018. Results Our systematic review identified 1481 patients with PCNSL. A preoperative LP obviated surgery in 7.4% of cases. Brain biopsy was the preferred method of diagnosis in 95% of patients followed by CSF (3.1%). In our institutional series, brain biopsy was diagnostic in 92.3% of cases (24/26) with 2 cases that required a second procedure for diagnosis. Perioperative morbidity was noted in 7.6% of cases (n = 2) due to hemorrhages after stereotactic brain biopsy that improved at follow-up. Conclusions The diagnostic yield of CSF analyses for PCNSL in immunocompetent patients remains exceedingly low. Our institutional series demonstrates that early biopsy for PCNSL is safe and accurate, and may avert protracted work-ups. We conclude that performing an early brain biopsy in a suspected case of PCNSL is a valid, safe option to minimize diagnostic delay.

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A Rare Case of Spontaneous Remission and Relapse of a Primary Central Nervous System Lymphoma

Acta Médica Portuguesa ◽

10.20344/amp.10198 ◽

2018 ◽

Vol 31 (12) ◽

pp. 777 ◽

Cited By ~ 1

Author(s):

Rui Ramos ◽

João Soares Fernandes ◽

Marta Almeida ◽

Rui Almeida

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Rare Case ◽

Central Nervous System Lymphoma ◽

Brain Biopsy ◽

B Cell Lymphoma ◽

Spontaneous Remission ◽

Neurological Deficits ◽

Pubmed Search ◽

The Central Nervous System

Primary central nervous system lymphoma remission after steroid treatment is a well-known phenomenon, but remission without any type of treatment is extremely rare. We present a rare case of spontaneous remission of a diffuse large B-cell lymphoma of the central nervous system as well as its subsequent reappearance in another location. The atypical presentation misled the neurosurgeons and neurologists, delaying diagnosis and treatment. The patient underwent brain biopsy after the relapse and started radiotherapy and chemotherapy with cytarabine + methotrexate + rituximab. As of 32 months after the diagnosis, the patient remained asymptomatic, with no focal neurological deficits and the disease in complete remission. A PubMed search of the literature up to June 2017 regarding spontaneous remission central nervous system lymphoma was also carried out.

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