P17.02 Diagnostic delay and treatment options of Primary Central Nervous System Lymphoma in the last decade: preliminary results of first 50 patients from two Catalan institutions

Abstract

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a challenging disease frequently misdiagnosed and associated with a considerable diagnostic delay. The aim of this study was to ascertain the diagnostic management and frequency of untreated PCNSL in two academic hospitals (Institut Catala d'Oncologia, L'Hospitalet and Hospital Clinic, Barcelona). METHODS: We reviewed the clinical records of all non‐immunosuppressed PCNSL patients diagnosed between2005 and2014. RESULTS: We identified 50 patients, 34 (68%) were men. Median age was 61.5 [range 30‐79] years old and 45 (90%) were of B‐cell origin. Most frequent symptoms at clinical presentation were: focal deficit (56%), cognitive impairment (17%), vertigo (18%), psychiatric (10%), visual (10%) and seizures (8%). MRI was performed in the almost all of patients (98%) at a median of 18 [range 1‐104] days after the first symptom onset. Multiple and bilateral localization at presentation was observed in 23 (46%) and 19 (38%) patients, respectively. Typical homogeneous contrast enhancement was present in 30 (60 %) patients, being atypical (ring or non‐homogeneous) in 14 (28%). In 4 (8%) patients the lesions did not enhance with gadolinium. Median time to pathological diagnosis from clinical onset was 49 days [95% confidence interval (CI), 36.90‐61.09 days] with no differences between patients who were treated or not with steroids (58 vs 42.5 days, p=0.563). PCNSL was confirmed by surgery in 47 (94%) patients. The other 3 patients were diagnosed by CSF cytology (2) or by necropsy (1). Complementary studies were PET (52%), body‐TC (50%), bone‐marrow (42%), lumbar puncture (36%), and ophthalmologic examination (18%). Only 39 (78%) patients received specific oncologic treatment. Reasons to withheld treatment included poor performance status and/or old age. CONCLUSION: Our study indicates that the delay between onset of symptoms and diagnosis is too long and that corticoid administration doesn't seem to be the main reason for this delay. Nearly one out of 4 patients is not treated after diagnosis. Currently a similar study is underway in 20 additional institutions from Spain to confirm these results.