Anjo Riemens1, Jacoline Bromberg2, Valerie Touitou3, Bianka Sobolewska4, Tom Missotten5, Seerp Baarsma5, Carel Hoyng6, Miguel Cordero-Coma7, Oren Tomkins-Netzer8, Anna Rozalski9, Ilknur Tugal-Tutkun10, Yan Guex-Crosier11, Leonoor I Los12, Jan Geert Bollemeijer13, Andrew Nolan14, Joya Pawade14, Francois Willermain15, Bahram Bodaghi3, Ninette ten Dam-van Loon1, Andrew Dick14, Manfred Zierhut4, Susan Lightman8, Friederike Mackensen9, Alexandre Moulin11, Roel Erckens16, Barbara Wensing17, Phuc le Hoang3, Henk Lokhorst18, Aniki Rothova19. 1. Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands. 2. Department of Neuro-Oncology, Erasmus Medical Centre, Rotterdam, the Netherlands. 3. Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France. 4. Department of Ophthalmology, Tübingen University Hospital, Tübingen, Germany. 5. Rotterdam Eye Hospital, Rotterdam, the Netherlands. 6. Department of Ophthalmology, Radboud Medical Centre, Nijmegen, the Netherlands. 7. Department of Ophthalmology, Uveitis Unit, University Hospital of León, León, Spain. 8. Moorfields Eye Hospital, London, England. 9. Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany. 10. Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 11. Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Lausanne, Switzerland. 12. Department of Ophthalmology, University Medical Center, Groningen, the Netherlands13W. J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands. 13. Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands. 14. Bristol Eye Hospital, Bristol, England. 15. Department of Ophthalmology, Centre Hospitalier Universitaire St-Pierre and Brugmann, Université Libre de Bruxelles, Bruxelles, Belgium. 16. Department of Ophthalmology, University Medical Centre, Maastricht, the Netherlands. 17. Department of Ophthalmology, Amsterdam Medical Centre, Amsterdam, the Netherlands. 18. Department of Hematology, University Medical Centre Utrecht, Utrecht, the Netherlands. 19. Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Abstract
IMPORTANCE: The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown. OBJECTIVE: To evaluate the outcomes of treatment regimens used for PVRL in the prevention of subsequent CNSL. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging data on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period. INTERVENTIONS: The term extensive treatment was used for various combinations of systemic and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy. MAIN OUTCOMES AND MEASURES: Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens. RESULTS: Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35% [95% CI, 50% to 86%]) than in patients without CNSL (68% [95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure. CONCLUSIONS AND RELEVANCE: In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.
IMPORTANCE: The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown. OBJECTIVE: To evaluate the outcomes of treatment regimens used for PVRL in the prevention of subsequent CNSL. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging data on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period. INTERVENTIONS: The term extensive treatment was used for various combinations of systemic and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy. MAIN OUTCOMES AND MEASURES: Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens. RESULTS: Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35% [95% CI, 50% to 86%]) than in patients without CNSL (68% [95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure. CONCLUSIONS AND RELEVANCE: In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.
Authors: Chan Yoon Cheah; Sarah Milgrom; Dai Chihara; Dan S Gombos; Chelsea C Pinnix; Bouthaina S Dabaja; Nathan H Fowler Journal: Neuro Oncol Date: 2015-10-20 Impact factor: 12.300