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

      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.

      Abbreviations:

      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)

      Keywords

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