Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review)

The cochleovestibular system is unique in that the peripheral labyrinth subserves two senses, hearing and balance, while the central auditory and vestibular connections diverge within the central nervous system and interact with a multiplicity of information from other sensory inputs. During the seventh decade of life, approximately 40% of people in Great Britain have a significant hearing impairment while in the eighth decade of life this figure rises to 60%. By the age of 65, 35% of people have experienced episodes of dizziness and by the age of 80, two-thirds of women and one-third of men have suffered episodes of vertigo. The elderly population is reported to be increasing by approximately 30% every 20 years and the prevalence of vertigo and hearing loss has been reported to rise in parallel with advancing age.

Download Full-text

Consolidation Treatment for Primary Central Nervous System Lymphoma: Which Modality for Whom?

Acta Haematologica ◽

10.1159/000511208 ◽

2020 ◽

pp. 1-14

Author(s):

Osnat Bairey ◽

Liat Shargian-Alon ◽

Tali Siegal

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Real Life ◽

Central Nervous System Lymphoma ◽

Whole Brain Radiotherapy ◽

Progression Free Survival ◽

The Elderly ◽

High Dose ◽

Brain Radiotherapy ◽

Randomized Studies

Primary central nervous system lymphoma is a rare aggressive disease that largely affects elderly patients and is associated with poor prognosis. The optimal treatment approach is not yet defined and it consists of induction and consolidation phases. The combination of high-dose (HD) methotrexate-based chemotherapy followed by whole-brain radiotherapy (WBRT) prolongs the median progression-free survival (PFS) and overall survival 2- to 3-fold as compared to WBRT alone but is associated with significant delayed neurotoxicity. Alternative strategies are being investigated in order to improve disease outcomes and spare patients the neurocognitive side effects. These include reduced-dose WBRT, non-myeloablative HD chemotherapy, or HD chemotherapy with autologous stem cell transplantation (HDC/ASCT). There are no randomized studies that compare all these consolidation regimens head to head but recently HDC/ASCT has been evaluated versus WBRT in prospective randomized studies. These studies proved that WBRT and HDC/ASCT yield similar 2-year PFS with preserved or improved cognitive function after HDC/ASCT. Yet, the proportion of patients treated with such intensive consolidation is low, both in real life and in specialized centers, leaving many unsettled issues. This review is appraising current dilemmas related to the choice of consolidating therapeutic modalities, their associated acute and delayed toxicity, and future prospects for alternative approaches in the elderly.

Download Full-text

Safety and efficacy of primary central nervous system lymphoma treatment in elderly population

Neurological Sciences ◽

10.1007/s10072-015-2371-2 ◽

2015 ◽

Vol 37 (1) ◽

pp. 131-133

Author(s):

Paola Gaviani ◽

G. Simonetti ◽

A. Innocenti ◽

E. Lamperti ◽

A. Botturi ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Elderly Population ◽

Central Nervous System Lymphoma ◽

Safety And Efficacy ◽

Lymphoma Treatment

Download Full-text

Case-based review: primary central nervous system lymphoma

Neuro-Oncology Practice ◽

10.1093/nop/npw033 ◽

2017 ◽

Vol 4 (1) ◽

pp. 46-59 ◽

Cited By ~ 1

Author(s):

Agnieszka Korfel ◽

Uwe Schlegel ◽

Derek R. Johnson ◽

Timothy J. Kaufmann ◽

Caterina Giannini ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Primary Cns Lymphoma ◽

Central Nervous System Lymphoma ◽

Whole Brain Radiotherapy ◽

B Cell Lymphoma ◽

The Elderly ◽

Cns Lymphoma ◽

High Dose ◽

Tumor Biopsy

Abstract Primary CNS lymphoma (PCNSL) is a rare diffuse large B-cell lymphoma originating within the central nervous system. The overall incidence of PCNSL is rising, particularly in the elderly population. Immunosuppression is a strong risk factor, but most patients with this tumor are apparently immunocompetent. Diagnosis of PCNSL can be challenging. Non-invasive or minimally invasive tests such as ophthalmological evaluation and spinal fluid analysis may be useful, but the majority of patients require tumor biopsy for definitive diagnosis. Our knowledge concerning optimum treatment of PCNSL is fragmentary due to paucity of adequately sized trials. Most patients are now initially treated with high-dose-methotrexate-based chemotherapy alone, as the addition of whole-brain radiotherapy at standard doses has not been shown to increase survival and does increase the risk of neurological toxicity. Ongoing trials are addressing issues such as the roles of reduced-dose radiotherapy, the addition of the CD20 antibody rituximab to chemotherapy, high-dose chemotherapy followed by autologous stem cell transplantation, and maintenance therapy in the primary management of PCNSL.

Download Full-text