title: Primary Central Nervous System Lymphomas of the Brain: A Retrospective Analysis in a Single Institution.
abstract: BACKGROUND
  Primary central nervous system lymphomas (PCNSLs) are relatively rare brain tumors. Accurate diagnosis is usually made by surgical biopsy. In addition to surgical biopsy and decompression, treatment options include high-dose methotrexate and chemotherapy, radiation therapy, and stem cell therapy. Because of the rarity of this disease, guidelines for PCNSL diagnosis and treatment usually are formed from a large series of experiences.
  
  
  METHODS
  We retrospectively reviewed 79 patients in our tertiary referral center during a 13-year period. All patients with PCNSL underwent surgical or bone marrow biopsy procedures, and diagnoses were confirmed by hematologists or neuropathologists. At the time of diagnosis, 44 patients presented with a single lesion. Human immunodeficiency virus was confirmed positive in 1 patient. The standard therapy protocol included high-dose methotrexate (intravenous and intrathecal) and chemotherapy with cytosine arabinoside, followed by external irradiation of the brain.
  
  
  RESULTS
  Significant prognostic factors in these patients were low serum lactate dehydrogenase levels and radiation therapy. Multiplicity of lesions at time of diagnosis did not imply a worse outcome, and surgical resection and debulking did not show a significant survival benefit.
  
  
  CONCLUSIONS
  PCNSL has a poor prognosis. Further clinical trials and diagnostic tools are needed to reveal the complexity of this disease.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Tzu-Kang
authors.initials: TK
authors.lastname: Lin
authors.affiliation: Department of Neurology, Taipei Medical University and Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Tu-Hsueh
authors.initials: TH
authors.lastname: Yeh
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Peng-Wei
authors.initials: PW
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Chuang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Tu
authors.affiliation: Department of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Pin-Yuan
authors.initials: PY
authors.lastname: Chen
authors.affiliation: Department of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Pathology, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan.
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Wei
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou branch, Taoyuan City, Taiwan; Department of Medicine, Chang Gung University, Taoyuan City, Taiwan. Electronic address: ns3068@gmail.com.
authors.forename: Yin-Cheng
authors.initials: YC
authors.lastname: Huang
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D001932:Brain Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002051:Burkitt Lymphoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016371:Cranial Irradiation; D003399:Craniotomy; D003561:Cytarabine / Q000008:administration & dosage; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008223:Lymphoma / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016399:Lymphoma, T-Cell / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D003561:Cytarabine; D007770:L-Lactate Dehydrogenase; D008727:Methotrexate
keywords: Chemotherapy; Overall survival; Primary CNS lymphoma; Radiation therapy