Resection of central nervous system lymphoma: a paradigm shift?
Central nervous system lymphomas (CNSL) are traditionally regarded as non-surgically treated tumors with a poor prognosis. Usually, only stereotactic biopsy is performed to establish the diagnosis, and most patients show disease progression within half a year. A recent study questioned this view, since patients who had surgical resection of CNSL manifestations prior to adjuvant therapy reportedly had a better outcome than patients who had biopsy only. We performed a retrospective analysis of our patient database to identify patients with CNSL who had undergone "accidental" tumor removal in our department between 2002 and 2013. Four patients had CNSL specific therapy following surgery. One patient received no further therapy because of his bad clinical status. Five patients with CNSL were treated surgically. Three patients were in complete remission at nine, thirteen and 45 months postoperatively, while two others had disease progression at 45 months, respectively. The median survival was 22.6 months. Gross total removal of CNSL may improve outcome. We present a series of five patients who had surgical resection of CNSL. While the importance of chemotherapy is beyond doubt, more data on the effect of surgery on the prognosis of patients with CNSL are needed. However, the paradigm of medical treatment only for CNSL is being challenged.
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany - n.brawanski@kgu.de.
Nina
N
Brawanski
Department of Hematology and Oncology, Goethe University Hospital, Frankfurt am Main, Germany.
Johannes
J
Atta
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Lutz M
LM
Weise
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Jürgen
J
Konczalla
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Johanna
J
Quick-Weller
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Marie-Therese
MT
Forster
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Gerhard
G
Marquardt
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Volker
V
Seifert
Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Christian
C
Senft
D000368:Aged; D001932:Brain Neoplasms / Q000601:surgery*; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome