The possible benefit from total tumour resection in primary diffuse large B-cell lymphoma of central nervous system – a one-decade single-centre experience

Abstract

Background and methods. The aim of the study was to evaluate retrospectively clinical course of 27 patients with primary central nervous system lymphoma (PCNSL) diagnosed and treated by different surgical approaches. Initial therapy-diagnostic approach included surgery with total tumour reduction (TTR) performed in 12 patients (44.4%), while partial reduction and biopsy were performed in 8 (29.7%) and 7 (25.9%) patients, respectively. All patients were treated with chemotherapy based on high-dose methotrexate (HD-MTX) with/without whole-brain radiotherapy (WBRT). Results. The median overall survival (OS) and event-free survival were 37 and 31 months, respectively, with overall response rate of 74%. The patients who underwent an open surgery with TTR had significantly longer OS (median not reached), comparing with partial tumour reduction or biopsy only (Log-Rank χ² 6.08, p = 0.014) when median OS was 23 months. In patients with performance status according to Eastern Cooperative Oncology Group (ECOG PS) ≥ 3, OS was 23 months, contrary to ECOG PS 1–2 when median was not reached. The International Extranodal Lymphoma Study Group score (low, intermediate and high) also influenced OS between three risk groups (Log-Rank χ² 12.5, p = 0.002). Conclusion. The treatment of PCNSL still remains doubtful, however possible benefit from the TTR followed with HD-MTX with/without WBRT should be reconsidered.

Keywords::

• brain
• brain neoplasm
• non-Hodgkin's lymphoma
• neurosurgery

Acknowledgement

JJ and MB wrote the paper; SR confirmed diagnoses of all patients and provided the list of potential patients; RI performed the majority of surgical interventions; DS performed statistical analyses; JB, DA, BA, VD, AS and VV collected all clinical data; BB performed graphical work and BM provided the instructions for realisation the paper.

Declaration of interest: This work was supported by the Ministry of Education, Science and Technological Development, Republic of Serbia Grant No. III 41004. The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the paper.