Cytoreductive Surgery for Primary Central Nervous System Lymphoma: Is it time to consider extent of resection?

Shaani Singhal, Ellathios Antoniou, Edward Kwan, Gareth Gregory, Leon T. Lai

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1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)110-116
Number of pages7
JournalJournal of Clinical Neuroscience
Volume106
DOIs
Publication statusPublished - Dec 2022
Externally publishedYes

Keywords

  • Overall survival
  • Primary Central Nervous System Lymphoma
  • Progression-free survival
  • Radiotherapy
  • Remission
  • Stereotactic biopsy
  • Surgical resection

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