Tzu-Kang Lin1, Tu-Hsueh Yeh2, Peng-Wei Hsu1, Chih-Cheng Chuang1, Po-Hsun Tu1, Pin-Yuan Chen3, Shih-Ming Jung4, Kuo-Chen Wei1, Yin-Cheng Huang5. 1. Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan. 2. Department of Neurology, Taipei Medical University and Taipei Medical University Hospital, Taipei, Taiwan. 3. Department of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan. 4. Department of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Pathology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan. 5. Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan. Electronic address: ns3068@gmail.com.
Abstract
BACKGROUND: Primary central nervous system lymphomas (PCNSLs) are relatively rare brain tumors. Accurate diagnosis is usually made by surgical biopsy. In addition to surgical biopsy and decompression, treatment options include high-dose methotrexate and chemotherapy, radiation therapy, and stem cell therapy. Because of the rarity of this disease, guidelines for PCNSL diagnosis and treatment usually are formed from a large series of experiences. METHODS: We retrospectively reviewed 79 patients in our tertiary referral center during a 13-year period. All patients with PCNSL underwent surgical or bone marrow biopsy procedures, and diagnoses were confirmed by hematologists or neuropathologists. At the time of diagnosis, 44 patients presented with a single lesion. Human immunodeficiency virus was confirmed positive in 1 patient. The standard therapy protocol included high-dose methotrexate (intravenous and intrathecal) and chemotherapy with cytosine arabinoside, followed by external irradiation of the brain. RESULTS: Significant prognostic factors in these patients were low serum lactate dehydrogenase levels and radiation therapy. Multiplicity of lesions at time of diagnosis did not imply a worse outcome, and surgical resection and debulking did not show a significant survival benefit. CONCLUSIONS: PCNSL has a poor prognosis. Further clinical trials and diagnostic tools are needed to reveal the complexity of this disease.
BACKGROUND:Primary central nervous system lymphomas (PCNSLs) are relatively rare brain tumors. Accurate diagnosis is usually made by surgical biopsy. In addition to surgical biopsy and decompression, treatment options include high-dose methotrexate and chemotherapy, radiation therapy, and stem cell therapy. Because of the rarity of this disease, guidelines for PCNSL diagnosis and treatment usually are formed from a large series of experiences. METHODS: We retrospectively reviewed 79 patients in our tertiary referral center during a 13-year period. All patients with PCNSL underwent surgical or bone marrow biopsy procedures, and diagnoses were confirmed by hematologists or neuropathologists. At the time of diagnosis, 44 patients presented with a single lesion. Human immunodeficiency virus was confirmed positive in 1 patient. The standard therapy protocol included high-dose methotrexate (intravenous and intrathecal) and chemotherapy with cytosine arabinoside, followed by external irradiation of the brain. RESULTS: Significant prognostic factors in these patients were low serum lactate dehydrogenase levels and radiation therapy. Multiplicity of lesions at time of diagnosis did not imply a worse outcome, and surgical resection and debulking did not show a significant survival benefit. CONCLUSIONS: PCNSL has a poor prognosis. Further clinical trials and diagnostic tools are needed to reveal the complexity of this disease.
Authors: Cylaina E Bird; Jeffrey I Traylor; Jenna Thomas; James P Caruso; Benjamin Kafka; Flavia Rosado; Kyle M Blackburn; Kimmo J Hatanpaa; Kalil G Abdullah Journal: Surg Neurol Int Date: 2021-09-13