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The role of surgery in intracranial PCNSL

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Abstract

This aimed to evaluate the effect of surgery for overall survival (OS) and progression-free survival (PFS) in intracranial primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center. A prospective database at Oslo University Hospital of PCNSL was reviewed over a 12-year period (2003–2014). Seventy-nine patients with intracranial PCNSL were identified. Deep brain involvement was shown in 63 patients. Thirty-two patients underwent craniotomy with resection, while all other patients had a biopsy. Fifty-seven patients were given chemotherapy: 18 were treated with the MSKCC (Memorial Sloan-Kettering Cancer Center) with rituximab, 21 with the MSKCC without rituximab, and 14 within a Nordic prospective phase II protocol. Forty-four patients achieved complete response (CR) and had OS of 46.3 months. Patients who underwent resection had a median OS of 28.6 versus 11.7 months for those who had a biopsy performed. Resection showed an insignificant prolongation of OS. Multivariate analysis confirmed statistical significance of deep brain involvement only (p < 0.005). Neither chemotherapy regimen, Karnofsky Performance Status (KPS), type of surgery, nor patient age was significant factors for OS or PFS. Resective surgery played no role in significantly improving either OS or PFS and therefore it is not recommended as treatment for PCNSL.

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Author notes

  1. Guro Jahr and Michele Da Broi contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital, 0027, Oslo, Norway

    Guro Jahr, Michele Da Broi & Torstein R. Meling

  2. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Michele Da Broi, Klaus Beiske & Torstein R. Meling

  3. Department of Oncology, Oslo University Hospital, Oslo, Norway

    Harald Holte Jr

  4. Department of Pathology, Oslo University Hospital, Oslo, Norway

    Klaus Beiske

Authors
  1. Guro Jahr
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  2. Michele Da Broi
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  3. Harald Holte Jr
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  4. Klaus Beiske
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  5. Torstein R. Meling
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Correspondence to Torstein R. Meling.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Data Protection Office at OUH (2015/16840).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Jahr, G., Da Broi, M., Holte, H. et al. The role of surgery in intracranial PCNSL. Neurosurg Rev 41, 1037–1044 (2018). https://doi.org/10.1007/s10143-018-0946-0

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  • DOI: https://doi.org/10.1007/s10143-018-0946-0

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