TY - JOUR
T1 - Treatment strategies in primary vitreoretinal lymphoma
T2 - a 17-center European collaborative study
AU - Riemens, Anjo
AU - Bromberg, Jacoline
AU - Touitou, Valerie
AU - Sobolewska, Bianka
AU - Missotten, Tom
AU - Baarsma, Seerp
AU - Hoyng, Carel
AU - Cordero-Coma, Miguel
AU - Tomkins-Netzer, Oren
AU - Rozalski, Anna
AU - Tugal-Tutkun, Ilknur
AU - Guex-Crosier, Yan
AU - Los, Leonoor I
AU - Bollemeijer, Jan Geert
AU - Nolan, Andrew
AU - Pawade, Joya
AU - Willermain, Francois
AU - Bodaghi, Bahram
AU - ten Dam-van Loon, Ninette
AU - Dick, Andrew
AU - Zierhut, Manfred
AU - Lightman, Susan
AU - Mackensen, Friederike
AU - Moulin, Alexandre
AU - Erckens, Roel
AU - Wensing, Barbara
AU - le Hoang, Phuc
AU - Lokhorst, Henk
AU - Rothova, Aniki
PY - 2015/2
Y1 - 2015/2
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Biopsy
KW - Cause of Death/trends
KW - Combined Modality Therapy/standards
KW - Disease-Free Survival
KW - Europe/epidemiology
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Lymphoma, Non-Hodgkin/diagnosis
KW - Male
KW - Middle Aged
KW - Practice Guidelines as Topic
KW - Retinal Neoplasms/diagnosis
KW - Retrospective Studies
KW - Survival Rate/trends
KW - Time Factors
KW - Treatment Outcome
KW - Vitreous Body/pathology
U2 - 10.1001/jamaophthalmol.2014.4755
DO - 10.1001/jamaophthalmol.2014.4755
M3 - Article
C2 - 25412269
SN - 2168-6165
VL - 133
SP - 191
EP - 197
JO - JAMA Ophthalmology
JF - JAMA Ophthalmology
IS - 2
ER -