Primary non-Hodgkin's lymphoma of the spine with neurologic compression treated by radiotherapy and chemotherapy alone or combined with surgical decompression

Abstract

Abstract. Neurologic compression is a disastrous consequence for the patients with primary non-Hodgkin's lymphoma (NHL) of the spine, and such a condition has not been carefully taken into account in the treatment guidelines. The aim of this study was to compare the effect of radiotherapy and chemotherapy alone or combined with surgical decompression on primary NHL of the spine with neurologic compression. Sixteen patients with primary NHL in the vertebrae of the spine were treated between 1994 and 2006. Thirteen patients had neurologic compression. The neurologic deficits in 11 patients involved soft tissue extension from the vertebral tumors and 3 had vertebral fractures with motor signs and 5 had radicular pain. Five patients were treated by radiotherapy and chemotherapy alone while 8 were combined with surgical decompression. The decompression operation for tumors resulted in neurologic recovery in 6 patients. Five patients were not operated on but three received emergent radiotherapy before chemotherapy, 4 of whom had complete recovery in their neurologic symptoms. Of all patients, 3 relapsed. At average follow-up of 61.5 months (range 2-156 months), 4 patients had died after an average interval of 23.3 months from treatment (range 3-71 months). The 5-year overall survival rate was 82% with 60% for the patients in the surgical group, 100% for the patients in the non-surgical group. There was no difference between the groups (¯2=3.559, P=0.059). The 5-year overall survival was 100% for the 8 patients who completed CHOP chemotherapy and radiotherapy. It appears that optimum treatment in these patients depends on the cause of the neurologic deficits, whereas the survival is not influenced by the surgical or nonsurgical treatment. The results suggest that chemotherapy and radiotherapy alone is the ideal treatment for these patients whose neurologic compression was only due to soft tissue extension. The authors emphasize the importance of chemotherapy and radiotherapy followed by surgical decompression depending on individual priorities in the indications for operation on primary NHL of spine with neurologic compression.

Surgical decompression improves recovery from neurological deficit and may provide a survival benefit in patients with diffuse large B-cell lymphoma-associated spinal cord compression: a case-series study

“…Our results suggest that surgical decompression may result in superior overall survival of DLBCL patients with spinal compression, even though statistical significance was lacking. This result is in contrast to the findings of a study conducted by Peng and colleagues that showed the 5-year overall survival rates for patients with primary non-Hodgkin's lymphoma of the spine with neurological compression in surgical and nonsurgical groups were 60% and 100%, respectively [6]. More well-designed clinical trials will therefore be required to clarify this controversial conclusion.…”

“…As DLBCL usually responds to chemotherapy within days, chemotherapy may be able to replace decompression surgery in DLBCL patients who have MASC. However, a study conducted by Peng and colleagues showed a negative impact of decompression surgery on survival in patients with primary spinal lymphoma complicated by spinal cord compression [6]. Owing to a lack of statistical power in that study, it remains unclear whether surgical decompression can benefit DLBCL patients with MASC.…”

Solitary Lymphoblastic Lymphoma of the Thoracic Spine

“…Primary lymphoma of bone usually responds well to a combination of radio- and chemotherapy regimens, and an overall response rate of 94% and a 5-year survival rate better than that achieved by most other primary osseous malignancies have been reported2). Peng et al10) also reported that combined chemotherapy and radiotherapy is the ideal treatment for primary non-Hodgkin's lymphoma of the spine, where as the survival is not influenced by the surgical or non-surgical treatment. In cases of severe pain or neurological deficits, however, early surgical decompression and stabilization is mandatory13).…”

A rare case of giant solitary spinal B cell lymphoblastic lymphoma

“…For Peng et al [10] the ideal treatment of vertebral lymphoma is chemotherapy combined with radiotherapy. Park et al [9] however argue that treatment of spinal lymphoma must be multifactorial including surgery, radiotherapy and chemotherapy.…”