[Primitif cerebral lymphoma]. / Lymphomes primitifs du système nerveux central.

Primitif cerebral lymphoma is a rare disease but has increased in incidence over the past decades. Most of them are diffuse B cell lymphomas. An ocular lymphoma (uveitis) is frequently associated. The clinical and radiological features are often suggestive but the diagnostic must be confirmed by histology (either by cerebral biopsy or cytology analysis of the CSF or vitrous). Despite therapeutic advances the prognostic remains poor (median survival range from 3 to 4 years) with frequent recurrences. High dose methotrexate followed by whole brain irradiation is the standard treatment and achieves a high rate of remission but the risk of delayed neurotoxicity is high. This complication is more frequent and severe for patients older than 60 years and chemotherapy alone is usually proposed in elderly people. Immunodeficiency is a contributing factor to the development of primitive cerebral lymphoma; in this setting, differentiating them from infectious lesions (toxoplasmosis in particular) may be difficult. These lymphomas have a poorerprognosis and radiotherapy without chemotherapy is often debated.

[Standards, Options and Recommendations 2002 for the management of adult patients with intracranial gliomas (summary report)]. / Standards, options et recommandations 2002 pour la prise en charge des patients atteints de gliomes intracrâniens de l'adulte (rapport abrégé).

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVE: To define clinical practice guidelines for the management of adult patients with intracranial glioma in collaboration with the Association of French-speaking Neuro-oncologists (Anocef) and the French society of neurosurgeons (SNCLF). These recommendations cover diagnosis, classification, treatment and follow-up of patients with these tumors. METHOD: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines has been defined, the document is submitted for review by independent reviewers. RESULTS: This article is a summary version of the full document presenting the clinical practice guidelines with algorithms. The main recommendations concern the place of the surgery, radiotherapy, chemiotherapy, imagery and concomitant medical treatments in the specific treatment strategy of grade III and IV glioma, grade II glioma, gliomatosis cerebri, pilocytic astrocytoma, subependymoma, xanthoastrocytoma, intracranial ependymoma and brain stem glioma.