Treatment strategy and evaluation of spinal non-Hodgkin′s lymphomas

English Keywords:Non-Hodgkin′s lymphomas of the spine  Treatment  Surgery  Chemotherapy  Radiotherapy

English Abstract:

  【Abstract】 Objectives: To discuss the choice, effectiveness and outcome of different treatment in patients with non-Hodgkin′s lymphomas of the spine. Methods: Between June 2006 and November 2012, 15 patients with spinal non-Hodgkin′s lymphomas undergoing treated in our department were reviewed retrospectively. There were 8 males and 7 females, with an average age of 42±18 years(range: 16 to 71 years old). 14 patients presented with local pain and 11 with neurologic deficits, 5 patients suffered from spinal cord compression(Frankel grade C in 3 patients, D in 2), 6 cases had caunda equina syndrome. CT guided percutaneous biopsy was performed on 11 patients, 8 of whom were lymphoma, 1 was misdiagnosed to Langerhans cell histiocytosis, 2 were diagnosed as small cell malignant tumor. The other 7 cases were histologically diagnosed as lymphoma postoperatively. Among all the 15 patients, 5 did not receive surgery, after diagnosis, 4 patients without severe neural dysfunction or segmental instability received chemotherapy alone, 1 patient with Cauda Equina syndrome who could not tolerate surgery received emergent radiotherapy followed by chemotherapy. Surgery was performed on 10 patients, 7 patients received open surgery due to neural compression with segmental unstableness, 1 patient did not receive further treatment, 4 patients undergone chemotherapy and radiotherapy, 2 patients received chemotherapy. 1 patient who failed in percutaneous biopsy and with segmental instability, received surgery followed by chemotherapy. 2 patients with pathological fracture received percutaneous vertebroplasty(PVP) and further chemotherapy and/or radiotherapy. At preoperation, the average Karnofsky performance score(KPS) was 47±18, and the average visual analog score(VAS) was 7.7±1.0. In non-surgical group, the average KPS was 62±18, the average VAS was 6.4±1.0 before treatment. Results: 15 patients were followed up for an average of 52±34 months(range: 3 to 108 months). 5 patients died(survival time: 3, 10, 10, 15, 25 months). All patient who suffered from local pain got complete pain relief in 3 cases. In the 11 patients with neurologic deficit, 3 were treated conservatively, the other 8 had surgical treatment. In surgical group, 4 patients with myelopathy had at least one Frankel grade improvement, including 2 complete recovery. All patients with cauda equina syndrome were significantly recovered after surgery. The average KPS was 91±15 in the latest follow-up, and the average VAS was 1.4±1.0(P<0.05). In the 5 non-surgical patients, 4 were alive, in the latest follow-up the average VAS was 1.0±0.6, the average KPS was 76±10 significantly improved after treatment(P<0.05). The estimated 5-year survival rate was 66.7%, while the estimated 5-year survival rate of surgical group was 60%, verses 80% in non-surgical group. Conclusions: For non-Hodgkin′s lymphoma of spine, chemotherapy and radiotherapy are the primary treatments. For patients with severe neurological deficit or obvious segmental unstableness, surgical treatment could be helpful to achieve pain relief, stabilization and neurological recovery, therefore improve life quality.