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van Rooij JLM, Tokarska KA, ten Dam-van Loon NH, Wessels PH, Seute T, Minnema MC, Snijders TJ. Central Nervous System Progression in Primary Vitreoretinal Lymphoma with Bilateral and Unilateral Involvement: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:2967. [PMID: 35740632 PMCID: PMC9221335 DOI: 10.3390/cancers14122967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Primary vitreoretinal lymphoma (PVRL) is either unilateral or bilateral at initial presentation. Progression to a central nervous system (CNS) lymphoma is regularly observed and these patients seem to have an inferior survival. Knowledge of the predictive value of laterality for CNS progression may facilitate risk stratification and the development of more effective treatment strategies, and eventually, improve outcomes. The objective of this analysis is to estimate the risk of CNS progression for patients with bilateral versus unilateral involvement of PVRL. METHODS Systematic literature search for studies on CNS progression in PVRL with bilateral and unilateral involvement according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We assessed the risk of bias and the methodological quality of studies using the Quality in Prognosis Studies (QUIPS) tool. Risk ratios of CNS progression in PVRL with bilateral and unilateral involvement were calculated and combined via a meta-analysis. RESULTS Twenty-five small-sized (total n = 371 cases) studies were included. The majority of the studies were at medium to high risk of bias. Results suggest no significant difference in CNS progression between bilateral and unilateral PVRL, with a pooled relative risk ratio of 1.12 (95% confidence interval 0.89-1.41). CONCLUSIONS CNS progression is common in PVRL. From the limited available evidence, there is no significant difference in CNS progression between bilateral and unilateral PVRL.
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Affiliation(s)
- Josephus L. M. van Rooij
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (J.L.M.v.R.); (K.A.T.); (T.S.)
| | - Klaudia A. Tokarska
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (J.L.M.v.R.); (K.A.T.); (T.S.)
| | | | - Peter H. Wessels
- Department of Neurology, St Antonius Hospital Utrecht/Nieuwegein, 3430 EM Nieuwegein, The Netherlands;
| | - Tatjana Seute
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (J.L.M.v.R.); (K.A.T.); (T.S.)
| | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands;
| | - Tom J. Snijders
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands; (J.L.M.v.R.); (K.A.T.); (T.S.)
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Zhao XY, Cheng TT, Meng LH, Zhang WF, Chen YX. Clinical Features, Diagnosis, Management and Prognosis of Primary Intraocular Lymphoma. Front Oncol 2022; 12:808511. [PMID: 35186744 PMCID: PMC8851327 DOI: 10.3389/fonc.2022.808511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the clinical features, diagnostic techniques, various treatment strategies and prognosis of primary intraocular lymphoma (PIOL).MethodsThe databases PubMed, EMBASE, and Ovid were searched from inception to March 2021 to identify relevant studies. Statistical analyses were performed with R version 3.3.1.Results87 studies involving 1484 patients (aged from 14 to 90 years old) were finally included. The pooling results indicated PIOL patients were female, elderly, binocular and B cell type dominated. About 19% have central nervous system (CNS) involvement at the first visit. During follow-up, the incidence of CNS involvement, death rate, 2-year and 5-year survival rate, 1-year and 2-year progression-free survival, and recurrence rate were 58%, 33%, 82%, 70%, 88%, 70%, 44%, respectively. The most common recurrent site was CNS. The delayed diagnosis rate was 85%, the misdiagnosed rate was 64%. The diagnostic technique with the highest positive rate was IL10:IL6>1 of aqueous (98%). The most common symptoms, signs, FFA and OCT features were blurring of vision (72%), vitreous inflammatory opacity (92%), FA/FAF reversal (91%) and hyper-reflective foci in posterior vitreous (53%), respectively. The prognosis of PIOL patients without CNS involvement was obviously better than those with CNS involvement. Overall, intravitreal injection of chemotherapy drug plus systemic chemotherapy (IV+CT) could achieve satisfactory prognosis, the combination of local radiotherapy (RT) could further decrease the recurrent and death rate.ConclusionPIOL patients with CNS involvement had significantly worse prognosis. The aqueous humor examination should be regarded as first-line and routine diagnostic technique. IV+CT could achieve satisfactory prognosis, the combination of RT was also beneficial.
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Affiliation(s)
- Xin-yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian-tian Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - You-xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: You-xin Chen, ;
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3
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Tropinskaya OF, Serova NK, Eliseeva NM. [Use of optical coherence tomography in diagnosis of retinal lymphomas]. Vestn Oftalmol 2022; 138:14-19. [PMID: 36573943 DOI: 10.17116/oftalma202213806114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Primary intraocular lymphomas (PIOL) affecting the vitreoretinal complex is a rare nosology, and because of that PIOLs often cause diagnostic difficulties and/or lead to misdiagnosis. In the event of retinal lesions, in addition to routine ophthalmoscopy, optical coherence tomography (OCT) of the retina plays an important role in the diagnosis of the disease. PURPOSE Evaluation of the characteristic features of retinal lymphomas using OCT. MATERIAL AND METHODS The study included 6 patients (10 eyes) with retinal lymphomas associated with brain lesions of diffuse large B-cell lymphoma (DLBCL) who were treated at the N.N. Burdenko National Medical Research Center of Neurosurgery from 2017 to 2020; they were examined with OCT. RESULTS All patients with retinal lymphomas showed typical OCT signs in the form of hyperreflective subretinal infiltrates. CONCLUSION OCT is a modern non-invasive method that allows diagnosing retinal lymphomas based on clinical and instrumental signs with a high degree of reliability.
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Affiliation(s)
- O F Tropinskaya
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - N K Serova
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - N M Eliseeva
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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4
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Lam M, Touitou V, Choquet S, Cassoux N, Ghesquières H, Kodjikian L, Schmitt A, Gattoussi S, Tabouret É, Sampo M, Blonski M, Angioi‐Duprez K, Houot R, Mouriaux F, Gyan E, Le Lez M, Moles M, Croisé F, Chauchet A, Schwartz C, Ahle G, Meyer L, Gressin R, Chiquet C, Oberic L, Ollé P, Marolleau J, Jany B, Tempescul A, Cochener B, Damaj G, Quintyn J, Moluçon‐Chabrot C, Rousseau E, Franciane P, Schneider C, Massé H, Tamburini‐Bonnefoy J, Brézin A, Fornecker L, Ballonzoli L, Le Garff‐Tavernier M, Hoang‐Xuan K, Bodaghi B, Soussain C, Houillier C. Intravenous high-dose methotrexate based systemic therapy in the treatment of isolated primary vitreoretinal lymphoma: An LOC network study. Am J Hematol 2021; 96:823-833. [PMID: 33864703 DOI: 10.1002/ajh.26199] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022]
Abstract
The treatment of primary vitreoretinal lymphoma (PVRL) remains controversial regarding the use of local, systemic, or combined treatments. The aim of this study was to analyze the efficacy and toxicity of intravenous high-dose methotrexate (IV HD-MTX) based systemic therapy in a uniformly treated population of PVRL patients. From a nationwide French database, we retrospectively selected 59 patients (median age: 70 years, median Karnofsky Performance Status: 90%) with isolated PVRL at diagnosis who received first-line treatment with HD-MTX between 2011 and 2018. 8/59 patients also received a local treatment. No deaths or premature discontinuations of MTX due to toxicity were reported. A complete response was obtained in 40/57 patients after chemotherapy. Before treatment, IL-10 was elevated in the aqueous humor (AH) or in the vitreous in 89% of patients. After treatment, AH IL-10 was undetectable in 87% of patients with a CR/uCR/PR and detectable in 92% of patients with PD/SD. After a median follow-up of 61 months, 42/59 (71%) patients had relapsed, including 29 isolated ocular relapses as the first relapse and a total of 22 brain relapses. The median overall survival, progression-free survival, ocular-free survival and brain-free survival were 75, 18, 29 and 73 months, respectively. IV HD-MTX based systemic therapy as a first-line treatment for isolated PVRL is feasible, with acceptable toxicity, even in an elderly population. This strategy seems efficient to prevent brain relapse with prolonged overall survival. However, the ocular relapse rate remains high. New approaches are needed to improve local control of this disease, and ocular assessment could be completed by monitoring AH IL-10.
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Affiliation(s)
- Marion Lam
- Ophthalmology, Assistance Publique – Hôpitaux de Paris (APHP) Groupe Hospitalier Pitié‐Salpêtrière Paris France
- Sorbonne Université Paris France
| | - Valérie Touitou
- Ophthalmology, Assistance Publique – Hôpitaux de Paris (APHP) Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Sylvain Choquet
- Hematology APHP, Groupe Hospitalier Pitié‐Salpêtrière, Sorbonne Université Paris France
| | - Nathalie Cassoux
- Ophthalmology, Institut Curie, Site Paris Université Paris V Descartes et PSL (Paris Science et Lettre) Paris France
| | - Hervé Ghesquières
- Hematology, Centre Hospitalier Lyon Sud Université Claude Bernard Lyon 1 Pierre‐Bénite France
| | - Laurent Kodjikian
- Ophthalmology, Croix‐Rousse University Hospital Université Claude Bernard Lyon 1 Lyon France
- Laboratoire UMR‐CNRS 5510 Matéis Université Lyon 1 Lyon France
| | | | - Sarra Gattoussi
- Ophthalmology Centre Hospitalier Universitaire de Bordeaux Bordeaux France
- University of Bordeaux, INSERM Bordeaux France
| | - Émeline Tabouret
- Neuro‐oncology, Assistance Publique – Hôpitaux de Marseille (AP‐HM), Timone Marseille France
- Aix‐Marseille Université, CRO2, UMR911 Marseille France
| | - Magali Sampo
- Ophthalmology Centre Hospitalier Intercommunal Toulon Toulon France
| | - Marie Blonski
- Neurology Centre Hospitalier Universitaire de Nancy Nancy France
| | - Karine Angioi‐Duprez
- Ophthalmology Centre Hospitalier Universitaire de Nancy, Université de Lorraine Nancy France
| | - Roch Houot
- Hematology Centre Hospitalier Universitaire de Rennes, Université de Rennes, INSERM U1236 Rennes France
| | - Frédéric Mouriaux
- Ophthalmology Centre Hospitalier Universitaire de Rennes Rennes France
| | - Emmanuel Gyan
- Hematology Centre Hospitalier Universitaire de Tours Tours France
| | | | | | - Fabien Croisé
- Ophthalmology Centre Hospitalier Universitaire de Angers Angers France
| | - Adrien Chauchet
- Hematology Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz Besançon France
| | - Claire Schwartz
- Ophthalmology Centre Hospitalier Universitaire de Besançon, Hôpital Jean Minjoz Besançon France
| | - Guido Ahle
- Neurology Hôpital Pasteur – Hôpitaux Civils de Colmar Colmar France
| | - Laurent Meyer
- Ophthalmology Hôpitaux civils de Colmar Colmar France
| | - Rémy Gressin
- Hematology Centre Hospitalier Universitaire de Grenoble Grenoble France
| | - Christophe Chiquet
- Grenoble Alpes University Grenoble France
- Ophthalmolgy Grenoble Alpes University Hospital Grenoble France
| | - Lucie Oberic
- Hematology Institut Universitaire du Cancer de Toulouse Oncopôle Toulouse France
| | | | | | - Benjamin Jany
- Ophthalmology Centre Hospitalier Universitaire de Amiens Amiens France
| | - Adrian Tempescul
- Hematology Centre Hospitalier Universitaire de Brest Brest France
| | - Béatrice Cochener
- Ophthalmology Centre Hospitalier Universitaire de Brest Brest France
| | - Gandhi Damaj
- Hematology Centre Hospitalier Universitaire de Caen, Université de Caen‐Normandie Caen France
| | | | | | - Eve Rousseau
- Ophthalmology Centre Hospitalier Universitaire de Gabriel Montpied Clermont‐Ferrand France
| | - Paul Franciane
- Hematology, Saint Eloi Hospital Montpellier University Hospital Montpellier France
| | - Christelle Schneider
- Ophthalmology Centre Hospitalier Universitaire Gui de Chauliac Montpellier France
| | - Hélène Massé
- Ophthalmology Centre Hospitalier Universitaire de Nantes Nantes France
| | | | | | | | - Laurent Ballonzoli
- Ophthalmology Centre Hospitalier Universitaire de Strasbourg Strasbourg France
| | | | - Khê Hoang‐Xuan
- Neurology APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Bahram Bodaghi
- Ophthalmology, Assistance Publique – Hôpitaux de Paris (APHP) Groupe Hospitalier Pitié‐Salpêtrière Paris France
| | - Carole Soussain
- Hematology Institut Curie Site Saint‐Cloud Paris France
- INSERM U932, Institut Curie, PSL Research University Paris France
| | - Caroline Houillier
- Neurology APHP Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié‐Salpêtrière Paris France
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Raval V, Binkley E, Aronow ME, Valenzuela J, Peereboom DM, Singh AD. Primary central nervous system lymphoma - ocular variant: an interdisciplinary review on management. Surv Ophthalmol 2021; 66:1009-1020. [PMID: 33762182 DOI: 10.1016/j.survophthal.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/26/2022]
Abstract
Primary central nervous system lymphoma-ophthalmic variant (PCNSL-O) is an ocular subset of PCNSL predominantly involving subretinal pigment epithelium space, retina, and vitreous. The ophthalmic manifestations can precede, occur simultaneously, or follow other compartments of the CNS. Clinical trials have resulted in a significantly improved outcome in PCNSL patients over the past 2 decades, with a higher proportion of patients receiving frontline high dose methotrexate-based polychemotherapy regimens with curative intent; however, the current management of PCNSL-O remains controversial owing to lack of prospective data. The goals of PCNSL-O treatment are both to achieve local (ocular) control and to prevent tumor-specific mortality from further CNS involvement. Despite achieving high rates of ocular control with intravitreal agents like methotrexate and rituximab, the overall survival is poor, as 65-85% of patients eventually succumb to CNS disease. Few studies define the role of systemic chemotherapy with/without local treatment as a first line induction treatment for PCNSL-O considering limiting factors such as ocular penetration of systemically administered drugs and treatment related neurotoxicity. Also, the role of adjuvant treatment for PCNSL-O to prevent CNS progression and to improve overall survival is unknown. In this systematic review of the literature, we analyze treatment outcomes of various regimens (local, systemic, and combination) in terms of local control, CNS progression, and overall survival.
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Affiliation(s)
- Vishal Raval
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elaine Binkley
- Department of Ophthalmology & Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Mary E Aronow
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Juan Valenzuela
- Department of Retina and Ophthalmic Oncology, Consultores Oftalmológicos, Buenos Aires, Argentina
| | - David M Peereboom
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Farrall AL, Smith JR. Eye involvement in primary central nervous system lymphoma. Surv Ophthalmol 2020; 65:548-561. [PMID: 32057762 DOI: 10.1016/j.survophthal.2020.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) may manifest initially in the eye (termed vitreoretinal lymphoma or VRL) or in non-ocular CNS compartments, or in both. The nature of the onset of PCNSL implies two clinical specialists - ophthalmologists and neuro-oncologists - independently may assess the primary presentation of this rare malignancy. Clinically relevant perspectives on expectations of PCNSL manifestation in both ocular and non-ocular CNS compartments would help inform management practices in each specialty, which should impact clinical outcomes. A recent increase in the number of published PCNSL cohort studies provides new opportunity to review the current prevalence rates of ocular involvement, and the timing of this involvement over the course of disease. In PCNSL cohorts defined by non-ocular CNS compartment involvement, with or without ocular involvement (termed "PCNSL ± ocular involvement" cohorts), mean rates of concomitant VRL at diagnosis, or at any time during the course, are 10% and 16%, respectively. Only a few individuals within this cohort group present with exclusive eye disease (<5%), and the rate of secondary ocular involvement is only 5-9%. In PCNSL cohorts defined by the involvement of the ocular compartment, with or without non-ocular CNS involvement (termed "VRL ± non-ocular CNS involvement" cohorts), 58% of persons have a primary ocular diagnosis, which carries a 50% risk of secondary involvement in the CNS beyond the eye. Rates of non-ocular CNS involvement with VRL at diagnosis or over the course of disease are 41% and 69%, respectively.
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Affiliation(s)
- Alexandra L Farrall
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
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Tropinskaya OF, Vetlova ER, Serova NK, Golanov AV, Fil'chenkova NA. [Multi-session stereotactic radiotherapy in the treatment of recurrent B-cell primary intraocular lymphoma (a case report)]. Vestn Oftalmol 2019; 134:78-85. [PMID: 29953086 DOI: 10.17116/oftalma2018134378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article describes the clinical observation of a 41-year-old woman suffering from non-Hodgkin's B-cell primary lymphoma of the central nervous system involving both eyes. The article features the data on 85-month follow-up, as well as description of the clinical and instrumental features of the disease. The study provides analysis of the long-term results of combined treatment of recurrent primary intraocular lymphoma including repeated courses of radiation therapy.
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Affiliation(s)
- O F Tropinskaya
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, 16, 4 ,Tverskaya-Yamskaya St., Moscow, Russian Federation, 125047
| | - E R Vetlova
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, 16, 4 ,Tverskaya-Yamskaya St., Moscow, Russian Federation, 125047
| | - N K Serova
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, 16, 4 ,Tverskaya-Yamskaya St., Moscow, Russian Federation, 125047
| | - A V Golanov
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, 16, 4 ,Tverskaya-Yamskaya St., Moscow, Russian Federation, 125047
| | - N A Fil'chenkova
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery, 16, 4 ,Tverskaya-Yamskaya St., Moscow, Russian Federation, 125047
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Ma WL, Hou HA, Hsu YJ, Chen YK, Tang JL, Tsay W, Yeh PT, Yang CM, Lin CP, Tien HF. Clinical outcomes of primary intraocular lymphoma patients treated with front-line systemic high-dose methotrexate and intravitreal methotrexate injection. Ann Hematol 2016; 95:593-601. [DOI: 10.1007/s00277-015-2582-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/16/2015] [Indexed: 12/17/2022]
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Tropinskaya OF, Vetlova ER, Serova NK, Golanov AV, Fil'chenkova NA. Radiotherapy of primary intraocular lymphoma associated with primary central nervous system lymphoma. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2016; 80:74-81. [PMID: 27296540 DOI: 10.17116/neiro201680374-81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM The aim of the study was to define indications for stereotactic radiotherapy (SRT) of primary intraocular lymphoma (PIOL) and to evaluate the SRT efficacy and toxicity level. MATERIAL AND METHODS Twelve immunocompetent patients with PIOL associated with primary CNS lymphoma underwent SRT of the affected eye/both eyes area. Three patients underwent repeated SRT due to PIOL recurrence. RESULTS An improvement in visual acuity occurred in 6 patients. No changes in the visual function were observed in patients with high visual acuity, patients with amaurosis, and patients with concomitant eye diseases. Tumoral infiltration of the vitreous body resolved/decreased in all patients, except one case with retinal PIOL. PIOL recurrence developed in 6 patients. The disease-free period ranged from 1 to 24 months. The development/progression of cataract was found in 2 patients. Temporary radiation epidermitis occurred in 7 patients. Three patients developed ocular hypertension. One patient had lower eyelid ectropion. CONCLUSION SRT is indicated for PIOL recurrence after intravitreal methotrexate injections, and in the case when local chemotherapy can not be used. In the case of combined injury to the brain and eyes, it is recommended that planned whole brain irradiation to involve the eyeball area. Local SRT is recommended if lymphoma locally affects the eye (or both eyes) without involvement of the brain. PIOL radiotherapy enables achieving persistent local disease control with minimal toxicity manifestations.
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Affiliation(s)
| | - E R Vetlova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - N K Serova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A V Golanov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Hämatologische Spezialdiagnostik und Therapieoptionen bei okulären Lymphomen unter Berücksichtigung einer ZNS-Beteiligung. Ophthalmologe 2015; 112:231-6. [DOI: 10.1007/s00347-014-3207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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