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[Primitif cerebral lymphoma].

Alexandra Benouaich-Amiel1, Gentian Kaloshi, Hoang-Xuan Khe

  • 1Service de neurologie Mazarin, groupe hospitalier La Pitié-Salpêtrière, 75651 Paris Cedex 13. alexandra.amiel-benouaich@psl.aphp.fr

La Revue Du Praticien
|February 24, 2007
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Summary

Primitive cerebral lymphoma, often diffuse B cell lymphoma, is increasing and linked to ocular lymphoma. Diagnosis requires histology, and while treatment improves remission, prognosis remains poor with significant neurotoxicity risks, especially in older adults.

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Area of Science:

  • Neurology
  • Oncology
  • Ophthalmology

Background:

  • Primitive cerebral lymphoma (PCL) is a rare malignancy with increasing incidence.
  • Diffuse B cell lymphomas constitute the majority of PCL cases.
  • Ocular lymphoma, specifically uveitis, is a common associated condition.

Purpose of the Study:

  • To review the clinical features, diagnosis, treatment, and prognosis of PCL.
  • To highlight diagnostic challenges, particularly differentiating PCL from infections in immunocompromised patients.
  • To discuss treatment strategies and associated toxicities.

Main Methods:

  • Review of clinical and radiological features suggestive of PCL.
  • Emphasis on histological confirmation via cerebral biopsy or CSF/vitreous cytology.
  • Analysis of standard treatment protocols and outcomes.

Main Results:

  • PCL prognosis remains poor, with a median survival of 3-4 years and frequent recurrences.
  • High-dose methotrexate followed by whole-brain irradiation is standard, achieving high remission rates but carrying a high risk of delayed neurotoxicity.
  • Elderly patients (>60 years) face higher neurotoxicity risks, often leading to chemotherapy-alone approaches.

Conclusions:

  • Histological confirmation is crucial for diagnosing PCL.
  • Standard treatment offers remission but poses significant neurotoxicity risks, necessitating careful patient selection and consideration of age-related factors.
  • The role of radiotherapy without chemotherapy in specific patient groups warrants further investigation.