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Morales-Martinez A, Nichelli L, Hernandez-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Prognostic factors in primary central nervous system lymphoma. Curr Opin Oncol 2022; 34:676-684. [PMID: 36093869 DOI: 10.1097/cco.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal diffuse large B cell lymphoma. Despite its apparent immunopathological homogeneity, PCNSL displays a wide variability in outcome. Identifying prognostic factors is of importance for patient stratification and clinical decision-making. The purpose of this review is to focus on the clinical, neuroradiological and biological variables correlated with the prognosis at the time of diagnosis in immunocompetent patients. RECENT FINDINGS Age and performance status remain the most consistent clinical prognostic factors. The current literature suggests that neurocognitive dysfunction is an independent predictor of poor outcome. Cumulating data support the prognostic value of increased interleukin-10 level in the cerebrospinal fluid (CSF), in addition to its interest as a diagnostic biomarker. Advances in neuroimaging and in omics have identified several semi-quantitative radiological features (apparent diffusion restriction measures, dynamic contrast-enhanced perfusion MRI (pMRI) pattern and 18F-fluorodeoxyglucose metabolism) and molecular genetic alterations with prognostic impact in PCNSL. SUMMARY Validation of new biologic and neuroimaging markers in prospective studies is required before integrating future prognostic scoring systems. In the era of radiomic, large clinicoradiological and molecular databases are needed to develop multimodal artificial intelligence algorithms for the prediction of accurate outcome.
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Affiliation(s)
| | - Lucia Nichelli
- APHP, Sorbonne Université, IHU, ICM, Service de Neuroradiologie, Groupe Hospitalier Salpêtrière
| | - Isaias Hernandez-Verdin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
| | | | - Agustí Alentorn
- APHP, Sorbonne Université, IHU, Service de Neurologie 2-Mazarin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
| | - Khê Hoang-Xuan
- APHP, Sorbonne Université, IHU, Service de Neurologie 2-Mazarin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
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Volpini ME, Song J, Samant R, MacDonald D, Nair VJ. Cranial Radiation Therapy as Salvage in the Treatment of Relapsed Primary CNS Lymphoma. Curr Oncol 2022; 29:8160-8170. [PMID: 36354704 PMCID: PMC9689217 DOI: 10.3390/curroncol29110644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 01/14/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare malignancy. Standard of care is upfront high-dose methotrexate (HD-MTX) chemotherapy, while cranial radiation is more commonly used in the salvage setting. In this retrospective study, we aimed to investigate the safety and efficacy of salvage cranial radiation in PCNSL. PCNSL patients who received upfront HD-MTX chemotherapy and salvage cranial radiation after treatment failure between 1995 and 2018 were selected. Radiological response to cranial radiation was assessed as per Response Assessment in Neuro-Oncology Criteria. Twenty one patients were selected (median age 59.9 years), with median follow-up of 19.9 months. Fourteen patients (66.7%) received a boost to the gross tumour volume (GTV). Four patients (19.0%) sustained grade ≥2 treatment-related neurotoxicity post-completion of cranial radiation. Of the 19 patients who had requisite MRI with gadolinium imaging available for Response Assessment in Neuro-Oncology (RANO) criteria assessment, 47.4% achieved complete response, 47.4% achieved partial response, and 5.3% of patients exhibited stable disease. Higher dose to the whole brain (>30 Gy) was associated with higher rate of complete response (63.6%) than lower dose (≤30 Gy, 37.5%), while boost dose to the gross disease was also associated with higher rate of complete response (61.5%) compared with no boost dose (33.3%). Median overall survival was 20.0 months. PCNSL patients who relapsed following upfront chemotherapy showed a high rate of response to salvage cranial radiation, especially in those receiving greater than 30 Gy to the whole brain and boost to gross disease.
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Affiliation(s)
- Matthew E. Volpini
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
- Correspondence: ; Tel.: +1-613-737-7700-x73396; Fax: 613-247-3528
| | - Jiheon Song
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Rajiv Samant
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - David MacDonald
- Division of Hematology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Vimoj J. Nair
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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Callovini GM, Sherkat S, Sperduti I, Crispo F, Raus L, Gazzeri R, Telera S. Hemorrhagic Attitude in Frameless and Frame-Based Stereotactic Biopsy for Deep-Seated Primary Central Nervous System Lymphomas in Immunocompetent Patients: A Multicentric Analysis of the Last Twenty Years. World Neurosurg 2021; 149:e1017-e1025. [PMID: 33476784 DOI: 10.1016/j.wneu.2021.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare manifestation of aggressive extranodal non-Hodgkin lymphoma. In patients with deep-seated lesions, stereotactic brain biopsy (SBB) is an accepted diagnostic procedure to obtain histopathologic confirmation. OBJECTIVE The aim of this study was to assess the feasibility, diagnostic yield, safety, and complications of stereotactic procedures in midline and deep-seated PCNSLs. METHODS Patients selected had received a histopathologic diagnosis of PCNSL localized in deep-seated midline structures, obtained by SBB. The intraoperative frozen section was executed as an integral part of the procedure. Computed tomography scan was performed after surgery. RESULTS A total of 476 SBBs were performed between January 2000 and December 2019 . Of these SBBs, 91 deep-seated lesions had a histologic diagnosis of PCNSL. A significant increase of the incidence of PCNSL compared with all other diseases was observed (P < 0.0001). Eight patients (8.7%) showed a symptomatic hemorrhage, 4 of whom required craniotomy. There were 4 deaths and 2 cases of permanent morbidity. The hemorrhage risk in the PCNSL group was statistically significant (P = 0.0003) compared with other histotypes. CONCLUSIONS In suspected cases of PCNSL, a histopathologic diagnosis is necessary to distinguish it from glioblastoma or other, nonmalignant conditions. Deep-seated PCNSLs present a higher risk of biopsy-related morbidity and mortality. Intraoperative frozen section increases the diagnostic yield and reduces the number of sampling procedures. Postoperative computed tomography seems to be warranted in patients with suspected PCNSL.
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Affiliation(s)
| | - Shahram Sherkat
- Department of Neurosurgery, San Filippo Neri Hospital, Rome, Italy
| | - Isabella Sperduti
- Departments of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Crispo
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Raus
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy; Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Telera
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Roetzer T, Furtner J, Gesperger J, Seebrecht L, Bandke D, Brada M, Brandner-Kokalj T, Grams A, Haybaeck J, Kitzwoegerer M, Leber SL, Marhold F, Moser P, Sherif C, Trenkler J, Unterluggauer J, Weis S, Wuertz F, Hainfellner JA, Langs G, Nenning KH, Woehrer A. Sex-Specific Differences in Primary CNS Lymphoma. Cancers (Basel) 2020; 12:cancers12061593. [PMID: 32560244 PMCID: PMC7352658 DOI: 10.3390/cancers12061593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022] Open
Abstract
Sex-specific differences have been increasingly recognized in many human diseases including brain cancer, namely glioblastoma. Primary CNS lymphoma (PCNSL) is an exceedingly rare type of brain cancer that tends to have a higher incidence and worse outcomes in male patients. Yet, relatively little is known about the reasons that contribute to these observed sex-specific differences. Using a population-representative cohort of patients with PCNSL with dense magnetic resonance (MR) imaging and digital pathology annotation (n = 74), we performed sex-specific cluster and survival analyses to explore possible associations. We found three prognostically relevant clusters for females and two for males, characterized by differences in (i) patient demographics, (ii) tumor-associated immune response, and (iii) MR imaging phenotypes. Upon a multivariable analysis, an enhanced FoxP3+ lymphocyte-driven immune response was associated with a shorter overall survival particularly in female patients (HR 1.65, p = 0.035), while an increased extent of contrast enhancement emerged as an adverse predictor of outcomes in male patients (HR 1.05, p < 0.01). In conclusion, we found divergent prognostic constellations between female and male patients with PCNSL that suggest differential roles of tumor-associated immune response and MR imaging phenotypes. Our results further underline the importance of continued sex-specific analyses in the field of brain cancer.
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Affiliation(s)
- Thomas Roetzer
- Division of Neuropathology & Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (J.G.); (L.S.); (J.A.H.); (A.W.)
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Johanna Gesperger
- Division of Neuropathology & Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (J.G.); (L.S.); (J.A.H.); (A.W.)
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
| | - Lukas Seebrecht
- Division of Neuropathology & Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (J.G.); (L.S.); (J.A.H.); (A.W.)
| | - Dave Bandke
- Division of Neuropathology, NeuromedCampus, Kepler University Hospital, Johannes Kepler University, 4040 Linz, Austria; (D.B.); (S.W.)
| | - Martina Brada
- Department of Pathology, Krankenanstalt Rudolfstiftung, 1030 Vienna, Austria;
| | - Tanisa Brandner-Kokalj
- Institute of Pathology, State Hospital Klagenfurt, 9020 Klagenfurt, Austria; (T.B.-K.); (F.W.)
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Johannes Haybaeck
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (J.H.); (J.U.)
- Department of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Melitta Kitzwoegerer
- Department of Pathology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, 3100 St. Poelten, Austria;
| | - Stefan L. Leber
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, 8036 Graz, Austria;
| | - Franz Marhold
- Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, 3100 St. Poelten, Austria;
| | - Patrizia Moser
- Department of Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Camillo Sherif
- Department of Neurosurgery, Krankenanstalt Rudolfstiftung, 1030 Vienna, Austria;
| | - Johannes Trenkler
- Institute of Neuroradiology, NeuromedCampus, Kepler University Hospital, Johannes Kepler University of Linz, 4020 Linz, Austria;
| | - Julia Unterluggauer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8036 Graz, Austria; (J.H.); (J.U.)
| | - Serge Weis
- Division of Neuropathology, NeuromedCampus, Kepler University Hospital, Johannes Kepler University, 4040 Linz, Austria; (D.B.); (S.W.)
| | - Franz Wuertz
- Institute of Pathology, State Hospital Klagenfurt, 9020 Klagenfurt, Austria; (T.B.-K.); (F.W.)
| | - Johannes A. Hainfellner
- Division of Neuropathology & Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (J.G.); (L.S.); (J.A.H.); (A.W.)
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Karl-Heinz Nenning
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence:
| | - Adelheid Woehrer
- Division of Neuropathology & Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (T.R.); (J.G.); (L.S.); (J.A.H.); (A.W.)
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Da Broi M, Jahr G, Beiske K, Holte H, Meling TR. Efficacy of the Nordic and the MSKCC chemotherapy protocols on the overall and progression-free survival in intracranial PCNSL. Blood Cells Mol Dis 2018; 73:25-32. [PMID: 30217760 DOI: 10.1016/j.bcmd.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To compare the Nordic and the Memorial Sloan-Kettering Cancer Center (MSKCC) chemotherapy protocols for Overall Survival (OS) and Progression-Free Survival (PFS) for intracranial primary CNS lymphoma (PCNSL). METHODS A prospective database at Oslo University Hospital of PCNSL was reviewed over a 12-year period (2003-2014). RESULTS Overall, 79 patients with PCNSL were identified, of whom 57 received chemotherapy. MSKCC with Rituximab (RTX) was used in 18 patients (32%) who had median OS of 46.3 months [9.8-131.9] and median PFS of 34.6 months [6.4-131.9]. The Nordic protocol was used in 14 patients (25%) who had median OS of 30.9 months [2.7-106.3] and PFS of 14.3 months [0.0-106.3]. The MSKCC was used without RTX in 25 patients (44%) who had OS of 15.2 months [0.7-136.5] and PFS of 12.0 months [0.0-117.0]. MSKCC with RTX had a significantly longer median OS (p < 0.05) compared to the other regimens in univariate analysis. In multivariate analysis, the only prognostic factor for OS and PFS of significance was deep brain involvement (p < 0.005). CONCLUSIONS In univariate analysis, the MSKCC with RTX achieved significantly longer median OS compared to the Nordic protocol. However, in multivariate analysis, the only prognostic factor for survival of statistical significance was deep brain involvement.
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Affiliation(s)
- Michele Da Broi
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Guro Jahr
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Klaus Beiske
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Harald Holte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Torstein R Meling
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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