Primary intracerebral malignant lymphoma: report of 248 cases

Restricted access

Object. The authors present a retrospective analysis of 248 immunocompetent patients with primary intracerebral lymphoma treated at 19 French and Belgian medical centers between January 1980 and December 1995.

Methods. This study involved 127 female and 121 male patients with a median age of 61 years (range 2–88 years). All tumors available for review were classic diffuse non-Hodgkin's lymphoma, for which the phenotype was determined in 220 patients: 212 (96.4%) were B-cell and eight (3.6%) were T-cell type tumors. According to the Revised European—American classification of lymphoid neoplasms, most lesions were diffuse large cell tumors (62%). A total of 196 tumors were reviewed in 127 patients for whom preoperative computerized tomography and magnetic resonance studies were available. There was a single lesion in 66% of the cases, with a supratentorial location in 87%. Tumor location in the basal ganglia, corpus callosum, or fornix, infiltration of the periventricular ependyma, or a mirror pattern, were strongly suggestive of a lesion of lymphomatous origin. The histological diagnosis was obtained after surgical resection in 116 patients, with the remainder undergoing biopsy sampling only. Of the 248 patients studied, 129 (52%) received chemotherapy plus radiation therapy, 60 (24%) received radiation therapy alone, 35 (14%) received chemotherapy alone, and 24 (10%) received no postsurgical treatment.

Conclusions. Using univariate analysis, the authors determined prognostic factors that were significantly associated with a favorable impact on survival including age younger than 60 years, radiation therapy (without evidence of a dose—response relationship), radiation therapy combined with chemotherapy, and chemotherapy consisting of anthracycline. Partial surgical resection was an unfavorable prognostic factor. Multivariate analysis was used to confirm the independent prognostic value of radiation therapy, age, chemotherapy consisting of anthracyclines or methotrexate, and partial surgical resection. This European survey provides a reasonable basis for the treatment of primary intracerebral lymphoma with the following sequence: stereotactic biopsy sampling, chemotherapy with a methotrexate- and anthracycline-based regimen, followed by cranial irradiation.

Article Information

Address reprint requests to: Benoit Bataille, M.D., Service de Neurochirurgie, Cité Hospitalière de La Milétrie, 350, Avenue Jacques Coeur, BP 577, 86021 Poitiers Cedex - France. email: b.bataille@chu-poitiers.fr.

© AANS, except where prohibited by US copyright law.

Headings

References

1.

Adams JHHowatson AG: Cerebral lymphomas: a review of 70 cases. J Clin Pathol 43:5445471990Adams JH Howatson AG: Cerebral lymphomas: a review of 70 cases. J Clin Pathol 43:544–547 1990

2.

Berry MPSimpson WJ: Radiation therapy in the management of primary malignant lymphoma of the brain. Int J Radiat Oncol Biol Phys 7:55591981Berry MP Simpson WJ: Radiation therapy in the management of primary malignant lymphoma of the brain. Int J Radiat Oncol Biol Phys 7:55–59 1981

3.

Bessell EMGraus FPunt JAGet al: Primary non-Hodgkin's lymphoma of the CNS treated with BVAM or CHOD/BVAM chemotherapy before radiotherapy. J Clin Oncol 14:9459541996Bessell EM Graus F Punt JAG et al: Primary non-Hodgkin's lymphoma of the CNS treated with BVAM or CHOD/BVAM chemotherapy before radiotherapy. J Clin Oncol 14:945–954 1996

4.

Blay JYBouhour DCarrie Cet al: The C5R protocol: a regimen of high-dose chemotherapy and radiotherapy in primary cerebral non-Hodgkin's lymphoma of patients with no known cause of immunosuppression. Blood 86:292229291995Blay JY Bouhour D Carrie C et al: The C5R protocol: a regimen of high-dose chemotherapy and radiotherapy in primary cerebral non-Hodgkin's lymphoma of patients with no known cause of immunosuppression. Blood 86:2922–2929 1995

5.

Blay JYGomez FSebban Cet al: The international prognostic index correlates to survival in patients with aggressive lymphoma in relapse: analysis of the PARMA trial. Blood 92:356235681998Blay JY Gomez F Sebban C et al: The international prognostic index correlates to survival in patients with aggressive lymphoma in relapse: analysis of the PARMA trial. Blood 92:3562–3568 1998

6.

Blay JYLasset CCarrie Cet al: Multivariate analysis of prognostic factors in patients with non HIV-related primary cerebral lymphoma. A proposal for a prognostic scoring. Br J Cancer 67:113611411993Blay JY Lasset C Carrie C et al: Multivariate analysis of prognostic factors in patients with non HIV-related primary cerebral lymphoma. A proposal for a prognostic scoring. Br J Cancer 67:1136–1141 1993

7.

Chan JKCBanks PMCleary MLet al: A proposal for classification of lymphoid neoplasms (by the International Lymphoma Study Group). Histopathology 25:5175631994Chan JKC Banks PM Cleary ML et al: A proposal for classification of lymphoid neoplasms (by the International Lymphoma Study Group). Histopathology 25:517–563 1994

8.

Corn BWMarcus SMTopham Aet al: Will primary central nervous system lymphoma be the most frequent brain tumor diagnosed in the year 2000? Cancer 79:240924131997Corn BW Marcus SM Topham A et al: Will primary central nervous system lymphoma be the most frequent brain tumor diagnosed in the year 2000? Cancer 79:2409–2413 1997

9.

Cox DR: Regression models and life tables. J R Stat Soc B 34:1872201972Cox DR: Regression models and life tables. J R Stat Soc B 34:187–220 1972

10.

David DLHoel DFox Jet al: Epidemiology. International trends in cancer mortality in France, West Germany, Italy, Japan, England and Wales, and the USA. Lancet 336:4744811990David DL Hoel D Fox J et al: Epidemiology. International trends in cancer mortality in France West Germany Italy Japan England and Wales and the USA. Lancet 336:474–481 1990

11.

DeAngelis LMYahalom JHeinemann MHet al: Primary CNS lymphoma: combined treatment with chemotherapy and radiotherapy. Neurology 40:80861990DeAngelis LM Yahalom J Heinemann MH et al: Primary CNS lymphoma: combined treatment with chemotherapy and radiotherapy. Neurology 40:80–86 1990

12.

DeAngelis LMYahalom JThaler HTet al: Combined modality therapy for primary CNS lymphoma. J Clin Oncol 10:6356431992DeAngelis LM Yahalom J Thaler HT et al: Combined modality therapy for primary CNS lymphoma. J Clin Oncol 10:635–643 1992

13.

Desablens BGardembas MLe Mevel Aet al: Seven-year results of 104 HIV-negative primary CNS lymphomas treated by the POF LCP 88 trial. Blood 88:5671996 (Abstract)Desablens B Gardembas M Le Mevel A et al: Seven-year results of 104 HIV-negative primary CNS lymphomas treated by the POF LCP 88 trial. Blood 88:567 1996 (Abstract)

14.

Eby NLGrufferman SFlannelly CMet al: Increasing incidence of primary brain lymphoma in the US. Cancer 62:246124651988Eby NL Grufferman S Flannelly CM et al: Increasing incidence of primary brain lymphoma in the US. Cancer 62:2461–2465 1988

15.

Ervin TCanellos GP: Successful treatment of recurrent primary central nervous system lymphoma with high-dose methotrexate. Cancer 45:155615571980Ervin T Canellos GP: Successful treatment of recurrent primary central nervous system lymphoma with high-dose methotrexate. Cancer 45:1556–1557 1980

16.

Fine HA: Treatment of primary cerebral central nervous system lymphoma: still more questions than answers. Blood 86:287328751995Fine HA: Treatment of primary cerebral central nervous system lymphoma: still more questions than answers. Blood 86:2873–2875 1995

17.

Fine HAMayer RJ: Primary central nervous system lymphoma. Ann Intern Med 119:109311041993Fine HA Mayer RJ: Primary central nervous system lymphoma. Ann Intern Med 119:1093–1104 1993

18.

Freeman CBerg JWCutler SJ: Occurrence and prognosis of extranodal lymphomas. Cancer 29:2522601972Freeman C Berg JW Cutler SJ: Occurrence and prognosis of extranodal lymphomas. Cancer 29:252–260 1972

19.

Glass JGruber MLCher Let al: Preirradiation methotrexate chemotherapy of primary central nervous system lymphoma: long-term outcome. J Neurosurg 81:1881951994Glass J Gruber ML Cher L et al: Preirradiation methotrexate chemotherapy of primary central nervous system lymphoma: long-term outcome. J Neurosurg 81:188–195 1994

20.

Gonzales DGSchuster-Uitterhoeve LJ: Primary non-Hodgkin's lymphoma of the central nervous system. Results of radiotherapy in 15 cases. Cancer 51:204820521983Gonzales DG Schuster-Uitterhoeve LJ: Primary non-Hodgkin's lymphoma of the central nervous system. Results of radiotherapy in 15 cases. Cancer 51:2048–2052 1983

21.

Grant JWvon Deimling A: Primary T-cell lymphoma of the central nervous system. Arch Pathol Lab Med 114:24271990Grant JW von Deimling A: Primary T-cell lymphoma of the central nervous system. Arch Pathol Lab Med 114:24–27 1990

22.

Harris NLJaffe ESStein Het al: A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 84:136113921994Harris NL Jaffe ES Stein H et al: A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 84:1361–1392 1994

23.

Hayakawa TTakakura KAbe Het al: Primary central nervous system lymphoma in Japan. A retrospective, cooperative study by CNS-lymphoma study group in Japan. J Neurooncol 19:1972151994Hayakawa T Takakura K Abe H et al: Primary central nervous system lymphoma in Japan. A retrospective cooperative study by CNS-lymphoma study group in Japan. J Neurooncol 19:197–215 1994

24.

Helle TLBritt RHColby TV: Primary lymphoma of the central nervous system. Clinicopathological study of experience at Stanford. J Neurosurg 60:941031984Helle TL Britt RH Colby TV: Primary lymphoma of the central nervous system. Clinicopathological study of experience at Stanford. J Neurosurg 60:94–103 1984

25.

Henry JMHeffner RR JrDillard SHet al: Primary malignant lymphomas of the central nervous system. Cancer 34:129313021974Henry JM Heffner RR Jr Dillard SH et al: Primary malignant lymphomas of the central nervous system. Cancer 34:1293–1302 1974

26.

Hobson DEAnderson BACarr Iet al: Primary lymphoma of the central nervous system: Manitoba experience and literature review. Can J Neurol Sci 13:55611986Hobson DE Anderson BA Carr I et al: Primary lymphoma of the central nervous system: Manitoba experience and literature review. Can J Neurol Sci 13:55–61 1986

27.

Hochberg FHMiller DC: Primary central nervous system lymphoma. J Neurosurg 68:8358531988Hochberg FH Miller DC: Primary central nervous system lymphoma. J Neurosurg 68:835–853 1988

28.

Jellinger KRadaskiewicz THSlowik F: Primary malignant lymphomas of the central nervous system in man. Acta Neuropathol 6 (Suppl):951021975Jellinger K Radaskiewicz TH Slowik F: Primary malignant lymphomas of the central nervous system in man. Acta Neuropathol 6 (Suppl):95–102 1975

29.

Jiddane MNicoli FDiaz Pet al: Intracranial malignant lymphoma. Report of 30 cases and review of the literature. J Neurosurg 65:5925991986Jiddane M Nicoli F Diaz P et al: Intracranial malignant lymphoma. Report of 30 cases and review of the literature. J Neurosurg 65:592–599 1986

30.

Kaplan ELMeier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:4574811958Kaplan EL Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481 1958

31.

Karnofsky DAAbelmann WHCraver LFet al: The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1:6346561948Karnofsky DA Abelmann WH Craver LF et al: The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1:634–656 1948

32.

Kim DGNam DHJung HWet al: Primary central nervous system lymphoma: variety of clinical manifestations and survival. Acta Neurochir 138:2802891996Kim DG Nam DH Jung HW et al: Primary central nervous system lymphoma: variety of clinical manifestations and survival. Acta Neurochir 138:280–289 1996

33.

Lennert KFeller AC: Histopathology of Non-Hodgkin Lymphomas. (Based on the Updated Kiel Classification.) Berlin: Springer-Verlag1990Lennert K Feller AC: Histopathology of Non-Hodgkin Lymphomas. (Based on the Updated Kiel Classification.) Berlin: Springer-Verlag 1990

34.

Letendre LBanks PMReese DFet al: Primary lymphoma of the central nervous system. Cancer 49:9399431982Letendre L Banks PM Reese DF et al: Primary lymphoma of the central nervous system. Cancer 49:939–943 1982

35.

Littman PWang CC: Reticulum cell sarcoma of the brain. A review of the literature and a study of 19 cases. Cancer 35:141214201975Littman P Wang CC: Reticulum cell sarcoma of the brain. A review of the literature and a study of 19 cases. Cancer 35:1412–1420 1975

36.

Loeffler JSErvin TJMauch Pet al: Primary lymphomas of the central nervous system: patterns of failure and factors that influence survival. J Clin Oncol 3:4904941985Loeffler JS Ervin TJ Mauch P et al: Primary lymphomas of the central nervous system: patterns of failure and factors that influence survival. J Clin Oncol 3:490–494 1985

37.

Mendenhall NPThar TLAgee OFet al: Primary lymphoma of the central nervous system. Computerized tomography scan characteristics and treatment results for 12 cases. Cancer 52:199320001983Mendenhall NP Thar TL Agee OF et al: Primary lymphoma of the central nervous system. Computerized tomography scan characteristics and treatment results for 12 cases. Cancer 52:1993–2000 1983

38.

Michalski JMGarcia DMKase Eet al: Primary central nervous system lymphoma: analysis of prognostic variables and patterns of treatment failure. Radiology 176:8558601990Michalski JM Garcia DM Kase E et al: Primary central nervous system lymphoma: analysis of prognostic variables and patterns of treatment failure. Radiology 176:855–860 1990

39.

Morgello SMaiese KPetito CK: T-cell lymphoma in the CNS: clinical and pathologic features. Neurology 39:119011961989Morgello S Maiese K Petito CK: T-cell lymphoma in the CNS: clinical and pathologic features. Neurology 39:1190–1196 1989

40.

Murphy JKO'Brien CJIronaide JW: Morphologic and immunophenotypic characterization of primary brain lymphomas using paraffin-embedded tissue. Histopathology 15:4494601989Murphy JK O'Brien CJ Ironaide JW: Morphologic and immunophenotypic characterization of primary brain lymphomas using paraffin-embedded tissue. Histopathology 15:449–460 1989

41.

Murray KKun LCox J: Primary malignant lymphoma of the central nervous system. Results of treatment of 11 cases and review of the literature. J Neurosurg 65:6006071986Murray K Kun L Cox J: Primary malignant lymphoma of the central nervous system. Results of treatment of 11 cases and review of the literature. J Neurosurg 65:600–607 1986

42.

Namasivayam JTeasdale E: The prognostic importance of CT features in primary intracranial lymphoma. Br J Radiol 65:7617651992Namasivayam J Teasdale E: The prognostic importance of CT features in primary intracranial lymphoma. Br J Radiol 65:761–765 1992

43.

Nelson DFMartz KLBonner Het al: Non-Hodgkin's lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 23:9171992Nelson DF Martz KL Bonner H et al: Non-Hodgkin's lymphoma of the brain: can high dose large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 23:9–17 1992

44.

O'Neill BPColgan JPEarle JD: Primary central nervous system lymphoma: unusual but characteristic clinical presentations. Ann Neurol 22:1621631987 (Abstract)O'Neill BP Colgan JP Earle JD: Primary central nervous system lymphoma: unusual but characteristic clinical presentations. Ann Neurol 22:162–163 1987 (Abstract)

45.

O'Neill BPIllig JJ: Primary central nervous system lymphoma. Mayo Clin Proc 64:100510201989O'Neill BP Illig JJ: Primary central nervous system lymphoma. Mayo Clin Proc 64:1005–1020 1989

46.

O'Sullivan MGWittle IRGregor Aet al: Increasing incidence of CNS primary lymphoma in south-east Scotland. Lancet 338:8958961991 (Letter)O'Sullivan MG Wittle IR Gregor A et al: Increasing incidence of CNS primary lymphoma in south-east Scotland. Lancet 338:895–896 1991 (Letter)

47.

Peto RPeto J: Asymptotically efficient rank invariant procedures (with discussion). J R Stat Soc A 135:1852071972Peto R Peto J: Asymptotically efficient rank invariant procedures (with discussion). J R Stat Soc A 135:185–207 1972

48.

Pollack IFLunsford LDFlickinger JCet al: Prognostic factors in the diagnosis and treatment of primary central nervous system lymphoma. Cancer 63:9399471989Pollack IF Lunsford LD Flickinger JC et al: Prognostic factors in the diagnosis and treatment of primary central nervous system lymphoma. Cancer 63:939–947 1989

49.

Sagerman RHCollier CHKing GA: Radiation therapy of microgliomas. Radiology 149:5675701983Sagerman RH Collier CH King GA: Radiation therapy of microgliomas. Radiology 149:567–570 1983

50.

Schaumburg HHPlank CRAdams RD: The reticulum cell sarcoma-microglioma group of brain tumours. A consideration of their clinical features and therapy. Brain 95:1992121972Schaumburg HH Plank CR Adams RD: The reticulum cell sarcoma-microglioma group of brain tumours. A consideration of their clinical features and therapy. Brain 95:199–212 1972

51.

Schultz CScott CSherman Wet al: Preirradiation chemotherapy with cyclophosphamide, doxorubicin, vincristine and dexamethasone for primary CNS lymphomas: initial report of radiation therapy oncology group protocol 88-06. J Clin Oncol 14:5565641996Schultz C Scott C Sherman W et al: Preirradiation chemotherapy with cyclophosphamide doxorubicin vincristine and dexamethasone for primary CNS lymphomas: initial report of radiation therapy oncology group protocol 88-06. J Clin Oncol 14:556–564 1996

52.

Schwechheimer KBraus DFSchwarzkopf Get al: Polymorphous high-grade B cell lymphoma is the predominant type of spontaneous primary cerebral malignant lymphoma. Historical and immunomorphological evaluation of computed tomography-guided stereotactic brain biopsies. Am Surg Pathol 18:9319371994Schwechheimer K Braus DF Schwarzkopf G et al: Polymorphous high-grade B cell lymphoma is the predominant type of spontaneous primary cerebral malignant lymphoma. Historical and immunomorphological evaluation of computed tomography-guided stereotactic brain biopsies. Am Surg Pathol 18:931–937 1994

53.

Selch MTShimizu KTDe Salles AFet al: Primary central nervous system lymphoma. Results at the Univerity of California at Los Angeles and review of the literature. Am J Clin Oncol 17:2862931994Selch MT Shimizu KT De Salles AF et al: Primary central nervous system lymphoma. Results at the Univerity of California at Los Angeles and review of the literature. Am J Clin Oncol 17:286–293 1994

54.

Skarin ATZuckerman KSPitman SWet al: High-dose methotrexate with folinic acid and in the treatment of advanced non-Hodgkin lymphoma including CNS involvement. Blood 50:103910471977Skarin AT Zuckerman KS Pitman SW et al: High-dose methotrexate with folinic acid and in the treatment of advanced non-Hodgkin lymphoma including CNS involvement. Blood 50:1039–1047 1977

55.

Socié GPiprot-Chauffat CSchlienger Met al: Primary lymphoma of the central nervous system. An unresolved therapeutic problem. Cancer 65:3223261990Socié G Piprot-Chauffat C Schlienger M et al: Primary lymphoma of the central nervous system. An unresolved therapeutic problem. Cancer 65:322–326 1990

56.

Spillane JAKendall BEMoseley IF: Cerebral lymphoma: clinical radiological correlation. J Neurol Neurosurg Psychiatry 45:1992081982Spillane JA Kendall BE Moseley IF: Cerebral lymphoma: clinical radiological correlation. J Neurol Neurosurg Psychiatry 45:199–208 1982

57.

Tomlinson FHKurtin PJSuman VJet al: Primary intracerebral malignant lymphoma: a clinicopathological study of 89 patients. J Neurosurg 82:5585661995Tomlinson FH Kurtin PJ Suman VJ et al: Primary intracerebral malignant lymphoma: a clinicopathological study of 89 patients. J Neurosurg 82:558–566 1995

58.

Vergier BRivel JMascarel Aet al: Lymphomes malins non hodgkiniens primitifs du système nerveux central. Analyse anatomo-clinique de 35 cas. Ann Pathol 10:2682741990Vergier B Rivel J Mascarel A et al: Lymphomes malins non hodgkiniens primitifs du système nerveux central. Analyse anatomo-clinique de 35 cas. Ann Pathol 10:268–274 1990

59.

Woodman RShin KPineo G: Primary non-Hodgkin's lymphoma of the brain. A review. Medicine 64:4254301985Woodman R Shin K Pineo G: Primary non-Hodgkin's lymphoma of the brain. A review. Medicine 64:425–430 1985

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 140 140 59
Full Text Views 278 278 15
PDF Downloads 131 131 8
EPUB Downloads 0 0 0

PubMed

Google Scholar