The role of surgery in primary central nervous system lymphomas

Primary central nervous system lymphomas (PCNSL) are infrequent. The traditional treatment of choice is chemotherapy. Complete resections have generally not been recommended, because of the risk of permanent central nervous system deficits with no proven improvement in survival. The aim of the current study was to compare survival among patients with PCNSL who underwent biopsy versus surgical resection.

Methods

A retrospective study was conducted on 50 patients with a confirmed diagnosis of PCNSL treated at our center from January 1994 to July 2015.

Results

Patients in the resection group exhibited significantly longer median survival time, relative to the biopsy group, surviving a median 31 months versus 14.5 months; p = 0.016.

Conclusions

In our series, patients who had surgical resection of their tumor survived a median 16.5 months longer than patients who underwent biopsy alone.

Keywords
lymphoma; therapeutics; biopsy; survival

Variables	Total n = 47	Biopsy n = 29	Resection n = 18	p-value
Demographics
Age of presentation; mean (range)	60 (25–84)	61 (27–81)	59 (25–84)	0.73
Men; n (%)	30 (64%)	16 (55%)	14 (78%)	0.13
Immunological status
Immunodeficient; n (%)	8 (17%)	5 (17%)	3 (17%)	0.96
Type of lymphoma
Type B	45 (96%)	28 (96.5%)	17 (94%)
Type T	1 (2%)	0 (0%)	1 (5.5%)	0.62
Type NK (natural killer)	1 (2%)	1 (3.4%)	0 (0%)
Manifestations; n (%)
Pyramidal	26 (55%)	17 (58.6%)	9 (50%)	0.56
Cognitive disorders	17 (36%)	7 (24%)	10 (55.5%)	0.03
Intracranial hypertension	4 (8.5%)	1 (3.4%)	3 (17%)	0.15
Engaged areas on MRI
Frontal lobe	21 (45%)	12 (41.4%)	9 (50%)	0.56
Basal ganglia	11 (23%)	10 (34.5%)	1 (5.5%)	0.033
Decussation through midline	4 (8.5%)	3 (10.3%)	1 (5.5%)	0.99
Multicentric	11 (23%)	7 (24.3%)	4 (22%)	0.99
Pattern; n(%)
Parenchyma	41 (87%)	26 (90%)	15 (83%)
Meningeal	3 (6.5%)	2 (7%)	1 (5.5%)	0.8
Mixed	3 (6.5%)	1 (3.4%)	2 (11%)

Variables	Total n = 47	Biopsy n = 29	Resection n = 18	p-value
Survival; median and range (months)	25 (2–218)	14.5 (2–77)	31 (4–194)	0.016
Preoperative ECOG; mean	1.4	1.55	1.16	0.21
Postoperative ECOG; mean	3.71	4.2	3.4	0.22
Deceased, n (%)	25 (53%)	15 (52%)	10 (55.5%)	0.8

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

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[1] Correspondence: Juan Francisco Villalonga; Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia, Departamento de Neurocirugía; Montañeses 2325 Ciudada Autonoma de Buenos Aires Buenos Aires C1428QK, Argentina; E-mail: jfvillalonga@hotmail.com