The possible benefit from total tumour resection in primary diffuse large B-cell lymphoma of central nervous system - a one-decade single-centre experience.
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 χ(2) 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 χ(2) 12.5, p = 0.002).


CONCLUSIONS
The treatment of PCNSL still remains doubtful, however possible benefit from the TTR followed with HD-MTX with/without WBRT should be reconsidered.
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.|b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.
Jelena
J
Jelicic
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.|b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.
Milena
M
Todorovic Balint
c Department of Histopathology , Clinical Centre of Serbia , Belgrade , Serbia.
Sava
S
Raicevic
d Clinic of Neurosurgery, Clinical Centre of Serbia , Belgrade , Serbia.
Rosanda
R
Ilic
e Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade , Serbia.
Dejana
D
Stanisavljevic
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.|b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.
Jelena
J
Bila
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.|b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.
Darko
D
Antic
f Institute for Transfusiology and Haemobiology of Military Medical Academy , Serbia, Belgrade , Serbia.
Bela
B
Balint
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.|b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.
Bosko
B
Andjelic
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.
Vladislava
V
Djurasinovic
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.
Aleksandra
A
Sretenovic
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.
Vojin
V
Vukovic
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.|b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.
Biljana
B
Mihaljevic
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
brain; brain neoplasm; neurosurgery; non-Hodgkin's lymphoma