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MeSH term: Central Nervous System Neoplasms
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Impact of lymphopenia on prognosis of patients with primary central nervous system lymphoma.
Eur J Cancer. 2017; 75:280-283 [PubMed] Related Publications
Primary Central Nervous System Lymphoma: A Critical Review of the Role of Surgery for Resection.
Arch Cancer Res. 2016; 4(2) [PubMed] Free Access to Full Article Related Publications
METHODS AND FINDINGS: A systematic review of the literature was performed to identify trials evaluating surgical options for the treatment of PCNSL.
CONCLUSION: In this review, we provide a critical overview of the evidence favoring and discouraging resection for PCNSL. This literature suffers from several biases and limitations that must be considered in the context of the extrapolation of this literature into clinical decision-making.
Neurolymphomatosis Appeared Following Primary Central Nervous System Lymphoma.
Intern Med. 2017; 56(4):463-464 [PubMed] Related Publications
Long-term survivors of primary central nervous system lymphoma.
Jpn J Clin Oncol. 2017; 47(2):101-107 [PubMed] Related Publications
Work-up and management of a high-risk patient with primary central nervous system lymphoma.
Cancer Biol Med. 2016; 13(4):514-518 [PubMed] Free Access to Full Article Related Publications
Development of primary central nervous system lymphoma in a systemic lupus erythematosus patient after treatment with mycophenolate mofetil and review of the literature.
Lupus. 2017; :961203317691370 [PubMed] Related Publications
[Retrospective study of 48 cases of primary central nervous system lymphoma].
Medicina (B Aires). 2017; 77(1):17-23 [PubMed] Related Publications
The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis.
J Neurooncol. 2017; [PubMed] Related Publications
Population-based experience on primary central nervous system lymphoma 2000-2012: the incidence is increasing.
Acta Oncol. 2017; :1-12 [PubMed] Related Publications
PATIENTS AND METHODS: All patients diagnosed with a PCNSL at Uppsala University Hospital 2000-2012 were identified. Altogether, 96 patients (50 women and 46 men) were included. The median age at diagnosis was 66 years (17-95).
RESULTS: There was a statistically significant increase in age-standardized incidence during the study period, 30 patients were diagnosed in the first half and 66 in the second half of the period. No patient had an HIV-infection. Two patients had undergone kidney transplantation and were treated with immunosuppressive drugs. A high proportion of the patients, 29%, had a history of an autoimmune or inflammatory disease. The prognosis was poor with a median survival of only four months. In the 70 (73%) patients treated with curative intention the median survival was 12 months. Patients treated with high-dose methotrexate, radiotherapy and/or temozolomide appeared to have a better survival. There was no improvement in survival during the study period or after the introduction of rituximab. There also was no difference in any of the analyzed variables that could explain the increased incidence.
CONCLUSION: In this population-based study we could confirm the previously described increased incidence of PCNSL. The prognosis remains poor despite the inclusion of treatment with rituximab during the study period. A high proportion of the patients had a history of an autoimmune or inflammatory disease not previously described but there was no increase during the study period.
Hyperglycemia is associated with poor survival in primary central nervous system lymphoma patients.
Tumori. 2016; :0 [PubMed] Related Publications
METHODS: The medical and neuroradiologic records of 50 patients with PCNSL at our institution over the past 15 years were analyzed. Patients were divided into 3 groups based on mean fasting plasma glucose (FPG) levels: normal (>110 mg/dL), prediabetes (110-125 mg/dL), and diabetes (≥126 mg/dL). We defined prediabetes and diabetes groups as hyperglycemia.
RESULTS: Forty-four percent of patients were in the prediabetes and diabetes groups. One-year survival rates were 73%, 66%, and 43% in normal, prediabetes, and diabetes groups, respectively. Univariate analysis revealed that high age, female sex, poor performance status, high mean FPG, and monotherapy were associated with shorter survival. Multivariable Cox regression analyses showed that high mean FPG and monotherapy were significant predictors of shorter survival (p = 0.036 and p = 0.000, respectively). The GLUT1 immunohistopathologic staining was performed in 34 cases, 20 of which (58%) showed variable levels of GLUT1 expression at the cell membrane and/or cytoplasm. Prediabetes and diabetes groups had a higher percentage of GLUT1-positive cells compared with the normal group (p = 0.015).
CONCLUSIONS: These findings indicate that hyperglycemia is associated with poor survival. The putative biological mechanism might involve differential GLUT1 expression between hyperglycemic and normal states in patients with PCNSL.
Genome-wide DNA methylation profiling identifies primary central nervous system lymphoma as a distinct entity different from systemic diffuse large B-cell lymphoma.
Acta Neuropathol. 2017; 133(2):321-324 [PubMed] Related Publications
The challenge of adequate imaging surveillance in primary central nervous system lymphoma.
Neuro Oncol. 2016; [PubMed] Related Publications
[Clinicopathological Features of Primary Central Nervous System Lymphoma and Their Influence on Prognosis of Desease].
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2016; 24(6):1776-1781 [PubMed] Related Publications
METHODS: Forty-two cases of PCNSL hospitallized in our hospital from January 2012 to December 2015 were selected, and the laboratory analysis, imaging examination, bone marrow analysis and pathological examination all were performed, 26 cases were treated by lumbar puncture combined with intrathecal injection of drugs (Ara C, dexamethason and methotrexate), 8 cases were treated by methotrexate combined with rituximab, 8 cases voluntanly abandon treatment after being diagnosed as PCNSL.
RESULTS: Headache accrued in 12 cases, diplopia in 2 cases, dizziness in 6 cases, limb weakness in 10 cases, amnesia in 2 cases, inhibited speech in 4 cases.Out of 42 patients 4 cases of peripheral T cell lymphoma, 38 cases of B cell lymphoma; 30 cases of multiple lesions, 12 cases of solitary lesions, 8 cases of corpus callosum, 8 cases of thalamus, 8 cases of frontal lobe, parietal lobe, temporal lobe, thalamus and other lesions, 2 cases of hydrocephalus, 2 cases of cerebral hemorrhage; and the patients HIV were negative. 8 cases erythrocyte sedimentation rate were faster, IgG, IgE and IgM levels increased to varying degrees in 42 cases, and the blood routine, liver function and blood coagulation examinations showed normal; There was no significant difference in the influence of the lumbar injection, methotrexate dose, radiation therapy, and hematopoietic stem cell transplantation on survival time(P>0.05); but there was significant difference in the influence of rituximab and number of lesions on survival time (P<0.05); there were significant differences in the effects of age and protein content in cerebrospinal fluid on therapeutic effecacy(P<0.05).
CONCLUSION: There is no significant difference in the imaging examination and clinical manifestation between PCNSL and other intracranial tumors. The lumbar puncture is an effective way to identify, the age, cerebrospinal fluid protein and the number of lesions are the adverse factors influencing the prognosis.
Utility of post-therapy brain surveillance imaging in the detection of primary central nervous system lymphoma relapse.
Eur J Cancer. 2017; 72:12-19 [PubMed] Related Publications
METHODS: Patients were consecutive PCNSL cases treated in Leon Berard Cancer Centre, Lyon, France, from 1985 to 2011. Histology was diffuse large B-cell lymphoma in 94%. Patients were treated by methotrexate (92%) and cytarabine (63%) based-chemotherapy followed by radiotherapy for 108 patients (51%). Clinical records were reviewed for details at relapse and relationship to planned imaging. The imaging follow-up strategy was performed according to each treating physicians.
RESULTS: Among 209 PCNSL patients, 127 complete response patients entered in post-treatment observation and 63 (50%) subsequently relapsed. Among the 125 evaluable patients, the majority of relapses (N = 49, 80%) was asymptomatic and identified before the planned brain imaging. Surveillance imaging detected relapses before symptoms in 12 patients who entered in post-therapy observation (10%). The median number of brain imaging during the follow-up was 7 (0-13). A total of 819 MRI/CT-scan were performed leading to the detection of 12 asymptomatic relapses. The one year OS rates were 41% and 58% for symptomatic and non-symptomatic relapses, respectively (P = 0.21).
CONCLUSION: The majority of PCNSL relapses occurred outside planned follow-up with no difference in patient outcome between symptomatic and asymptomatic relapses. The role of brain imaging for the detection of relapses in the follow-up of PCNSL patients remains to be clarified.
Promoter methylation attenuates SHP1 expression and function in patients with primary central nervous system lymphoma.
Oncol Rep. 2017; 37(2):887-894 [PubMed] Related Publications
Intravitreal injections of methotrexate in treatment of primary central nervous system lymphoma with intraocular involvement.
Kaohsiung J Med Sci. 2016; 32(12):638-639 [PubMed] Related Publications
Management of primary central nervous system lymphoma in children.
Hematology Am Soc Hematol Educ Program. 2016; 2016(1):386-389 [PubMed] Related Publications
Primary central nervous system lymphoma.
Hematology Am Soc Hematol Educ Program. 2016; 2016(1):379-385 [PubMed] Related Publications
Can morphological MRI differentiate between primary central nervous system lymphoma and glioblastoma?
Cancer Imaging. 2016; 16(1):40 [PubMed] Free Access to Full Article Related Publications
METHODS: We retrospectively evaluated standard diagnostic MRI examinations in 54 immunocompetent patients (26 female, 28 male; age 62.6 ± 11.5 years) with histologically-proven PCNSL and 54 GBM subjects (21 female, 33 male; age 59 ± 14 years).
RESULTS: Several significant differences between both infiltrative brain tumors were found. PCNSL lesions enhanced homogenously in 64.8% of cases, while nonhomogeneous enhancement was observed in 98.1% of GBM cases. Necrosis was present in 88.9% of GBM lesions and only 5.6% of PCNSL lesions. PCNSL presented as multiple lesions in 51.9% cases and in 35.2% of GBM cases; however, diffuse infiltrative type of brain involvement was observed only in PCNSL (24.1%). Optic pathways were infiltrated more commonly in PCNSL than in GBM (42.6% vs. 5.6%, respectively, p <0.001). Other cranial nerves were affected in 5.6% of PCNSL, and in none of GBM. Signs of bleeding were rare in PCNSL (5.6%) and common in GBM (44.4%); p < 0.001. Both supratentorial and infratentorial localization was present only in PCNSL (27.7%). Involvement of the basal ganglia was more common in PCNSL (55.6%) than in GBM (18.5%); (p < 0.001). Cerebral cortex was affected significantly more often in GBM (83.3%) than in PCNSL (51.9%); mostly by both enhancing and non-enhancing infiltration.
CONCLUSION: Routine morphological MRI is capable of differentiating between GBM and PCNSL lesions in many cases at time of initial presentation. A solitary infiltrative supratentorial lesion with nonhomogeneous enhancement and necrosis was typical for GBM. PCNSL presented with multiple lesions that enhanced homogenously or as diffuse infiltrative type of brain involvement, often with basal ganglia and optic pathways affection.
The Challenge of Primary Central Nervous System Lymphoma.
Hematol Oncol Clin North Am. 2016; 30(6):1293-1316 [PubMed] Article available free on PMC after 01/12/2017 Related Publications
Primary central nervous system lymphoma of T-cell origin: an unusual cause of spinal cord disease.
Acta Neurol Belg. 2016; [PubMed] Related Publications
A Case of Primary Central Nervous System Lymphoma Located at Brain Stem in a Child.
Brain Tumor Res Treat. 2016; 4(2):155-159 [PubMed] Article available free on PMC after 01/12/2017 Related Publications
5-Aminolaevulinic Acid-Induced Fluorescence in Primary Central Nervous System Lymphoma.
World Neurosurg. 2017; 98:375-380 [PubMed] Related Publications
METHODS: This retrospective study includes clinical, magnetic resonance imaging, pathologic and surgical data of selected 11 patients with PCNSL at two university hospitals within the last 4 years undergoing surgical treatment for resection because of imminent mass effect or suspected cerebral glioma. Patients received 5-ALA for fluorescence-guided resection preoperatively.
RESULTS: The 11 subjects age ranged from 59 to 81 years. Postsurgical pathologic workup revealed malignant B cell lymphoma with morphologic features of diffuse large B cell lymphoma. Eight of these 11 patients with PCNSL showed a clear fluorescence induced by 5-ALA. After surgical resection, patients were treated with combination chemotherapy regimens.
CONCLUSION: In patients with glioma, the use of 5-ALA is known to be associated with increased extent of resection and survival benefit. Our data and retrospective analysis of a larger patient cohort suggest that the use of 5-ALA in PCNSL should be included in a surgical approach, if this is reconsidered for select patients within a clinical study. In addition, even photodynamic therapy in combination with 5-ALA might be studied.
[Manifestations of PET/CT Imaging in Primary Central Nervous System Lymphoma].
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2016; 24(5):1416-1420 [PubMed] Related Publications
METHODS: A retrospective analysis of PET/CT imaging manifestations and clinical data was performed in 4 PCNSL cases which were confirmed by surgery or stereotactic pathologic biopsy.
RESULTS: The pathologic biopsy in 4 patients all showed diffuse large B cell lymphoma with a total of 8 lesions. All cases were performed with (18)F-FDG PET/CT imaging except 1 patient simultaneously with (18)F-FLT PET/CT imaging in the brain. Single lesion was found in 2 cases which both were located in the left frontal lobe. Multiple lesions were found in 2 cases, out of them 1 case located in the corpus callosum and the right lateral ventricle Angle, and the other 1 located in dual lateral ventricle and pineal region. In (18)F-FDG PET/CT image, 4 patients were characterized by high metabolism, even higher than the surrounding brain tissue. The patient which underwent (18)F-FLT PET/CT imaging was also presented with high metabolism and had better Target and non-target ratio(T/N). 3 cases with surrounded by edema and 2 cases with area of cystic necrosis.
CONCLUSION: PCNSL are characterized by high metabolism in (18)F-FDG PET/CT images and can better contrast with the surrounding normal brain. Combined use of other tracer such as (18)F-FLT can improve the diagnostic value of PET/CT in PCNSL.
Promising treatment results with blood brain barrier disruption (BBBD) based immunochemotherapy combined with autologous stem cell transplantation (ASCT) in patients with primary central nervous system lymphoma (PCNSL).
J Neurooncol. 2017; 131(2):293-300 [PubMed] Related Publications
Utility of dynamic contrast-enhanced magnetic resonance imaging for differentiating glioblastoma, primary central nervous system lymphoma and brain metastatic tumor.
Eur J Radiol. 2016; 85(10):1722-7 [PubMed] Related Publications
MATERIALS AND METHODS: Seventy-five patients with histopathologically confirmed GBMs (n=38), PCNSLs (n=16) and MTs (n=21) underwent dynamic contrast-enhanced MRIs before surgery. The volume transfer constant K(trans), the flux rate constant between extravascular extracellular space and plasma Kep, the extravascular extracellular volume Ve and the fractional plasma volume Vp were measured within the entire contrast-enhancing tumor by extended Tofts model. A one-way analysis of variance was used to compare all of the parameters among these three tumors, followed by the post-hoc test. Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the permeability parameters.
RESULTS: Mean K(trans) value and Ve value were significantly higher in PCNSLs than in GBMs (P<0.001 and P=0.011) and MTs (P<0.001 and P<0.001). No significant difference was observed in all of the permeability parameters between GBMs and MTs. According to the receiver operating characteristic analyses, both K(trans) and Ve had good diagnostic performance for discriminating between PCNSLs and GBMs (the area under the curve: 0.847 and 0.785, respectively), as well as between PCNSLs and MTs (the area under the curve: 0.851 and 0.884, respectively).
CONCLUSIONS: The K(trans) and Ve derived from dynamic contrast-enhanced MRI facilitate the differentiation of PCNSLs from GBMs and MTs.
Health-related quality of life in outpatients with primary central nervous system lymphoma after radiotherapy and high-dose methotrexate chemotherapy.
Mol Clin Oncol. 2016; 5(3):179-185 [PubMed] Article available free on PMC after 01/12/2017 Related Publications
Long-term survival in AIDS-related primary central nervous system lymphoma.
Neuro Oncol. 2017; 19(1):99-108 [PubMed] Article available free on PMC after 01/01/2018 Related Publications
METHODS: To identify therapy-related factors associated with favorable survival, we first retrospectively analyzed outcomes of AR-PCNSL patients treated at San Francisco General Hospital, a public hospital with a long history of dedicated care for patients with HIV and AIDS-related malignancies. Results were validated in a retrospective, multicenter analysis that evaluated all newly diagnosed patients with AR-PCNSL treated with cART plus high-dose methotrexate (HD-MTX).
RESULTS: We provide evidence that CD4+ reconstitution with cART administered during HD-MTX correlates with long-term survival among patients with CD4 <100. This was confirmed in a multicenter analysis which demonstrated that integration of cART regimens with HD-MTX was generally well tolerated and resulted in longer progression-free survival than other treatments. No profound differences in immunophenotype were identified in an analysis of AR-PCNSL tumors that arose in the pre- versus post-cART eras. However, we detected evidence for a demographic shift, as the proportion of minority patients with AR-PCNSL increased since advent of cART.
CONCLUSION: Long-term disease-free survival can be achieved in AR-PCNSL, even among those with histories of opportunistic infections, limited access to health care, and medical non-adherence. Given this, as well as the long-term toxicities of WBRT, we recommend that integration of cART plus first-line HD-MTX be considered for all patients with AR-PCNSL.
Primary Central Nervous System Lymphoma (PCNSL): Analysis of Treatment by Gamma Knife Radiosurgery and Chemotherapy in a Prospective, Observational Study.
Cureus. 2016; 8(7):e697 [PubMed] Article available free on PMC after 01/01/2018 Related Publications
METHODS: This is a prospective, observational cohort study evaluating the treatment of histologically confirmed PCNSL with MTX as a single agent in a dose of 8 g/m2 (control) and treatment with MTX, plus GKRS. Strict inclusion and exclusion criteria were employed. Primary outcomes were measured by survival rate. Secondary outcomes were assessed by the tumor's responsiveness to treatment and reduction in size as noted on imaging.
RESULTS: Between January 2007 and January 2012, 128 charts were evaluated. Included in this evaluation were 73 chemotherapy (control) and 55 chemotherapy, plus GKRS, patients (variable). The follow-up period was 24 to 49 months (mean: 36.9 months). There were no statistically significant differences in patient demographics or histology diagnosis. Patients were treated with GK doses ranging from 11 Gy to 16 Gy (median: 11 Gy). The median survival rate from initial diagnosis was 26.8 months in the chemotherapy group and 47.6 in the chemotherapy, plus GKRS, group (p-value: 0.0034). All lesions showed a complete response after GKRS when evaluated using magnetic resonance imaging after three to eight weeks (mean range: 6.3 weeks).
CONCLUSIONS: The use of GKRS is non-invasive, safe, and shows rapid success, improving the prognosis of the patient. This noninvasive treatment modality should be considered as an option for patients with PCNSL. In our study, GKRS as a co-adjuvant therapy to high-dose methotrexate was statistically significant for greater tumor control, enhanced overall survival period, and a lesser number of complications.
[Analysis of the Clinical Characteristics and Prognostic Factors of 31 Cases of Primary Central Nervous System Lymphoma].
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2016; 24(4):1061-5 [PubMed] Related Publications
METHODS: Clinical records of 31 cases of PCNSL were collected, the clinical charactenstics were analyzed retrospectively. Survival curves were estimated using Kaplan-Meier survival methodology and statistical significance of continuous variables was assessed via the Cox proportional hazard model.
RESULTS: The median age was 52 years, with a ratio of male to female 1:1. Headache/dizzy/limb numbness were the most common presentation and the lesions of PCNSL were primarily located at the frontal, parietal, temporal lobes and corpus callosum. All the cases were pathologically diffuse large B cell lymphoma (DLBCL), 6 cases were the type of germinal center (GC) and 25 cases of non-GC type, after craniotomy operation and biopsy. Among 31 cases, 17 patients accepted the combined treatment, 3 patients underwent simple chemotherapy, 8 patients received simple radiotherapy, the other patients accepted support therapy. The median follow-up for surviving patients was 24 months. The 1-, 3-, and 5-year survival rates were 80.6%, 55.1%, and 36.4%, respectively. The median overall survival time in the combined treatment group was significantly longer than that in simply radiotherapy. There was no significant difference in OS between the groups with and without rituximab. ECOG PS≥2 and elevated serum LDH predicted inferior survival.
CONCLUSION: The clinical manifectation of PCNSL is various and complicated, and for the time being there is no optimal treatment scheme. The overall survival time of the combined treatment is longer than that in simply radiotherapy. ECOG PS≥2 and elevated serum LDH often are poor prognostic factors.