Treatment strategies in primary vitreoretinal lymphoma: a 17-center European collaborative study.

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.

Report on a review of the funding for construction of the Lewis and Clark Interpretive Center at Lewis and Clark State Park in Monona County for the period February 25, 1999 through December 31, 2008

Report on a review of the funding for construction of the Lewis and Clark Interpretive Center at Lewis and Clark State Park in Monona County for the period February 25, 1999 through December 31, 2008

Audit report on the City of Center Point, Iowa for the year ended June 30, 2009

Audit report on the City of Center Point, Iowa for the year ended June 30, 2009

Agreed-upon procedures report on the Iowa State Center Business Office of Iowa State University of Science and Technology for the year ended June 30, 2009

Agreed-upon procedures report on the Iowa State Center Business Office of Iowa State University of Science and Technology for the year ended June 30, 2009

Audit report on the Central Iowa Juvenile Detention Center in Eldora, Iowa for the year ended June 30, 2009

Audit report on the Central Iowa Juvenile Detention Center in Eldora, Iowa for the year ended June 30, 2009

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2009

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2009

Special investigation of the Country Living Care Center in Toledo, Iowa for the period July 1, 2007 through April 30, 2009

Special investigation of the Country Living Care Center in Toledo, Iowa for the period July 1, 2007 through April 30, 2009

Audit report on the City of Dallas Center, Iowa for the year ended June 30, 2010

Audit report on the City of Dallas Center, Iowa for the year ended June 30, 2010

Report on the Central Iowa Center for Independent Living (CICIL) for the period July 1, 2008 through June 30, 2009

Report on the Central Iowa Center for Independent Living (CICIL) for the period July 1, 2008 through June 30, 2009

Reaudit report on Skiff Medical Center in Newton, Iowa for the period July 1, 2008 through June 30, 2009

Reaudit report on Skiff Medical Center in Newton, Iowa for the period July 1, 2008 through June 30, 2009

Audit report on the City of Center Point, Iowa for the year ended June 30, 2010

Audit report on the City of Center Point, Iowa for the year ended June 30, 2010

Report on a special investigation of the Eastern Iowa Center for Problem Gambling for the period May 1, 2007 through April 30, 2009

Report on a special investigation of the Eastern Iowa Center for Problem Gambling for the period May 1, 2007 through April 30, 2009

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2010

Report on the Iowa Department of Human Services – Central Distribution Center for the year ended June 30, 2010