Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2013 | Research

Surgical decompression improves recovery from neurological deficit and may provide a survival benefit in patients with diffuse large B-cell lymphoma-associated spinal cord compression: a case-series study

Authors: Ching-Ming Chang, Hung-Chieh Chen, Youngsen Yang, Ren-Ching Wang, Wen-Li Hwang, Chieh-Lin Jerry Teng

Published in: World Journal of Surgical Oncology | Issue 1/2013

Abstract

Background

Malignancy-associated spinal cord compression is generally treated by surgical decompression, radiotherapy or a combination of both. Since diffuse large B-cell lymphoma (DLBCL) is highly sensitive to both chemotherapy and radiotherapy, the role of surgical decompression in the treatment of DLBCL-associated spinal cord compression remains unclear. We therefore conducted a retrospective review to investigate the impact of surgical decompression on recovery from neurological deficit caused by DLBCL-associated spinal cord compression and patients’ overall survival.

Methods

Between March 2001 and September 2011, 497 newly diagnosed DLBCL patients were reviewed, and 11 cases had DLBCL-associated spinal cord compression. Six cases were treated surgically and five cases nonsurgically.

Results

The rates of complete recovery from neurological deficit were 100% (6/6) and 20% (1/5) for patients in the surgical and nonsurgical groups, respectively (P = 0.015), while the median survival for patients in the surgical and nonsurgical groups was 48.6 months and 17.8 months, respectively (P = 0.177).

Conclusions

We conclude that surgical decompression can improve recovery from neurological deficit in patients with DLBCL-associated spinal cord compression, possibly providing these patients a survival benefit.

Prasad D, Schiff D: Malignant spinal-cord compression. Lancet Oncol. 2005, 6: 15-24.CrossRefPubMed

Ramadan KM, Shenkier T, Sehn LH, Gascoyne RD, Connors JM: A clinicopathological retrospective study of 131 patients with primary bone lymphoma: a population-based study of successively treated cohorts from the British Columbia Cancer Agency. Ann Oncol. 2007, 18: 129-135.CrossRefPubMed

Akram H, Allibone J: Spinal surgery for palliation in malignant spinal cord compression. Clin Oncol (R Coll Radiol). 2010, 22: 792-800. 10.1016/j.clon.2010.07.007.CrossRef

Coiffier B: Rituximab in combination with CHOP improves survival in elderly patients with aggressive non-Hodgkin's lymphoma. Semin Oncol. 2002, 29: 18-22.CrossRefPubMed

Flowers CR, Sinha R, Vose JM: Improving outcomes for patients with diffuse large B-cell lymphoma. CA Cancer J Clin. 2010, 60: 393-408.PubMed

Peng X, Wan Y, Chen Y, Chen L, He A, Liao W, Shen J, Fu Q, Han S, Li F, Zou X: Primary non-Hodgkin's lymphoma of the spine with neurologic compression treated by radiotherapy and chemotherapy alone or combined with surgical decompression. Oncol Rep. 2009, 21: 1269-1275.CrossRefPubMed

Jaffe ES: The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program. 2009, 523-531. 10.1182/asheducation-2009.1.523.

Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC, Rosenberg SA, Coltman CA, Tubiana M: Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting. J Clin Oncol. 1989, 7: 1630-1636.PubMed

Maynard FM, Bracken MB, Creasey G, Ditunno JF, Donovan WH, Ducker TB, Garber SL, Marino RJ, Stover SL, Tator CH, Waters RL, Wilberger JE, Young W: International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord. 1997, 35: 266-274. 10.1038/sj.sc.3100432.CrossRefPubMed

10.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982, 5: 649-655. 10.1097/00000421-198212000-00014.CrossRefPubMed

11.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009, 45: 228-247. 10.1016/j.ejca.2008.10.026.CrossRefPubMed

12.

A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. 1993, 329: 987-994.

13.

Vanneuville B, Janssens A, Lemmerling M, de Vlam K, Mielants H, Veys EM: Non-Hodgkin's lymphoma presenting with spinal involvement. Ann Rheum Dis. 2000, 59: 12-14. 10.1136/ard.59.1.12.PubMedCentralCrossRefPubMed

14.

Cole JS, Patchell RA: Metastatic epidural spinal cord compression. Lancet Neurol. 2008, 7: 459-466. 10.1016/S1474-4422(08)70089-9.CrossRefPubMed

15.

Cabanillas F: Front-line management of diffuse large B cell lymphoma. Curr Opin Oncol. 2010, 22: 642-645. 10.1097/CCO.0b013e32833ed848.CrossRefPubMed

16.

Phan J, Mazloom A, Jeffrey Medeiros L, Zreik TG, Wogan C, Shihadeh F, Rodriguez MA, Fayad L, Fowler N, Reed V, Horace P, Dabaja BS: Benefit of consolidative radiation therapy in patients with diffuse large B-cell lymphoma treated with R-CHOP chemotherapy. J Clin Oncol. 2010, 28: 4170-4176. 10.1200/JCO.2009.27.3441.CrossRefPubMed

17.

Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR: A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine. 2010, 35: E1221-E1229. 10.1097/BRS.0b013e3181e16ae2.CrossRefPubMed

18.

Popa C, Popa F, Grigorean VT, Onose G, Sandu AM, Popescu M, Burnei G, Strambu V, Sinescu C: Vascular dysfunctions following spinal cord injury. J Med Life. 2010, 3: 275-285.PubMedCentralPubMed

19.

Ramsey S, McIlhenny C: Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient. Spinal Cord. 2011, 49: 948-954. 10.1038/sc.2011.50.CrossRefPubMed

20.

Gelis A, Stefan A, Colin D, Albert T, Gault D, Goossens D, Perrouin-Verbe B, Fattal C, Pelissier J, Coudeyre E: Therapeutic education in persons with spinal cord injury: a review of the literature. Ann Phys Rehabil Med. 2011, 54: 189-210. 10.1016/j.rehab.2011.03.004.CrossRefPubMed

21.

Pfreundschuh M, Kuhnt E, Trumper L, Osterborg A, Trneny M, Shepherd L, Gill DS, Walewski J, Pettengell R, Jaeger U, Zinzani PL, Shpilberg O, Kvaloy S, de Nully Brown P, Stahel R, Milpied N, Lopez-Guillermo A, Poeschel V, Grass S, Loeffler M, Murawski N: CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group. Lancet Oncol. 2011, 12: 1013-1022. 10.1016/S1470-2045(11)70235-2.CrossRefPubMed

22.

Rodrigues CA, Patah PA, Novis YA, Hosing C, de Lima M: The role of transplantation in diffuse large B-cell lymphoma: the impact of rituximab plus chemotherapy in first-line and relapsed settings. Curr Hematol Malig Rep. 2011, 6: 47-57. 10.1007/s11899-010-0075-5.CrossRefPubMed

Title: Surgical decompression improves recovery from neurological deficit and may provide a survival benefit in patients with diffuse large B-cell lymphoma-associated spinal cord compression: a case-series study
Authors: Ching-Ming Chang
Hung-Chieh Chen
Youngsen Yang
Ren-Ching Wang
Wen-Li Hwang
Chieh-Lin Jerry Teng
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2013
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/1477-7819-11-90

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical decompression improves recovery from neurological deficit and may provide a survival benefit in patients with diffuse large B-cell lymphoma-associated spinal cord compression: a case-series study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Total gastrectomy increases the incidence of grade III and IV toxicities in patients with gastric cancer receiving adjuvant TS-1 treatment

Clinical features and outcomes of neck lymphatic metastasis in ovarian epithelial carcinoma

A gasless laparoscopic technique of wide excision for gastric gastrointestinal stromal tumor versus open method

Neuroendocrine small cell rectal cancer metastasizing to the liver: a unique treatment strategy, case report, and review of the literature

Expression of metallothionein and Nrf2 pathway genes in lung cancer and cancer-surrounding tissues

Focused abdominal ultrasound in preoperative liver surgery staging: a prospective study