Cytoreductive Surgery for Primary Central Nervous System Lymphoma: Is it time to consider extent of resection?. (December 2022)

• Record Type: Journal Article
• Authors: Singhal, Shaani; Antoniou, Ellathios; Kwan, Edward; Gregory, Gareth; Lai, Leon T.
• Is Part Of: Journal of clinical neuroscience. Volume 106(2022)
• Page Start: 110
• Page End: 116
• Publication Date: 2022-12
• Subjects: PCNSL Primary Central Nervous System Lymphoma -- NHL Non-Hodgkin Lymphoma -- CNS Central Nervous System -- CSF Cerebrospinal Fluid -- DLBCL Diffuse Large B-Cell Lymphoma -- GTR Gross Total Resection -- PFS Progression-Free Survival -- OS Overall Survival -- EOR Extent of Resection -- TTR Time to Remission -- RIC Response to Initial Chemotherapy -- TTC Time to Chemotherapy -- PET Positron Emission Tomography -- CT Computed Tomography -- LDH Lactate Dehydrogenase -- RMPV Rituximab, Methotrexate, Procarbazine, Vincristine -- MRI Magnetic Resonance Imaging -- CR Complete Response -- PR Partial Response -- RECIST Response Evaluation Criteria in Solid Tumours -- RANO Response Assessment in Neuro-Oncology -- WBRT Whole Brain Radiotherapy -- STR Sub Total Resection -- KM Kaplan-Meier -- AKPS Australia Karnofsky Performance Status; Primary Central Nervous System Lymphoma -- Stereotactic biopsy -- Surgical resection -- Progression-free survival -- Overall survival -- Remission -- Radiotherapy; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2022.10.008
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Our data suggests a potential benefit of cytoreductive surgery for selected patients with PCNSL. Although not statistically significant, there was a trend towards improved OS, reduced TTR, greater RIC, and reduced WBRT requirement. Abstract: Background: Cytoreductive surgery for Primary Central Nervous System Lymphoma (PCNSL) is controversial and is not routinely practiced. Cumulative literature in recent years, however, suggests a potential survival benefit associated with a greater extent of resection. Methods: A retrospective single institution cohort analysis of 58 consecutive patients with PCNSL was conducted between January 2011 and December 2020. Demographic, clinical, and radiographic characteristics were compared between patients with and without cytoreductive surgery following diagnosis of PCNSL. The primary outcome measures were progression-free survival (PFS) and overall survival (OS). Secondary outcome measures included time to remission (TTR), time to chemotherapy (TTC) and response to initial chemotherapy (RIC). Results: Forty-six patients (79.3 %) received stereotactic biopsy and 12 (20.6 %) underwent cytoreductive surgery. There was a trend towards longer OS (29.8 vs 22.3 months, p = 0.672), shorter TTR (4.0 vs 4.7 months, p = 0.362), and greater complete or near-complete radiographic RIC (81.8 % vs 67.6 %, p = 0.367) for patients undergoing cytoreductive surgery. This correlated with a lesser need for whole brain radiotherapy (WBRT) (8.3 % vs 19.6 %, p = 0.359). Conclusion: Our data suggests a potential benefit of cytoreductive surgery for selected patients diagnosed with PCNSL. Although not statistically significant, there was a trend towards improved OS, reduced TTR, greater RIC, and reduced WBRT requirement. Further studies with better randomization and statistical power are needed to validate this correlation.