Update: Primary central nervous system lymphoma surgery

Although few data are available in the scientific literature, surgery has traditionally been deemed to have no role in the treatment of primary central nervous system lymphoma. This widely adopted opinion is based on small retrospective series, the results of which suggest no clear benefits in the outcome of surgical resection when used as a sole treatment, compared with supportive care (class IIIb) 1) and compared with evidence from biopsy samples from patients who received postoperative chemotherapy or radiotherapy (class IIIb) 2) 3).

The absence of surgical effectiveness might be attributable to the microscopic, multifocal, and infiltrative nature of primary CNS lymphoma that can extend beyond the visible border of the lesion 4). The high radiosensitivity and chemosensitivity of primary CNS lymphoma, and the risk of postoperative morbidity in this patient population, have likewise helped discourage surgery. However, the recommendation to restrict surgical interventions to biopsies is not based on randomised data and, more importantly, not on contemporary data based on modern neurosurgical techniques. The German Primary CNS Lymphoma Study Group-1 (G-PCNSL-SG-1) phase 3 trial 5) included an unusually high proportion of operated patients, which allowed a large retrospective analysis of the association of surgery and expected outcome. Patients with subtotal or total resections had significantly longer progression-free survival and overall survival than did patients who received biopsies. This difference in outcome was independent of the postoperative Karnofsky Performance Score and age. Since patients who had a biopsy more often had many deeply-seated CNS lesions than patients who received surgery, this difference might have contributed to the unfavourable outcomes in the patients who had biopsies. When adjusted for the number of lesions (depth of lesions was not analysed in the study), the difference in outcome remained statistically significant for progression free survival, but not for overall survival(class 3a6).

Guidelines

To rapidly reduce intracranial pressure, surgical resection can be undertaken in patients with large lesions and acute symptoms of brain herniation (good practice point).
In patients suspected of primary central nervous system lymphoma with a unifocal and resectable lesion, the panel did not establish consensus about whether to recommend surgical resection or the need for tissue biopsy 7).

1) Henry JM, Heffner RR, Dillard SH, et al. Primary malignant lymphomas of the central nervous system. Cancer 1974; 34: 1293–302.
2) Bataille B, Delwail V, Menet E, et al. Primary intracerebral malignant lymphoma: a report of 248 cases. J Neurosurg 2000; 92: 261–66.
3) Bellinzona M, Roser F, Ostertag H, et al. Surgical removal of primary central nervous system lymphomas (PCNSL) presenting as space occupying lesions: a series of 33 cases. Eur J Surg Oncol 2005; 31: 100–05.
4) Lai R, Rosenblum MK, DeAngelis LM. Primary CNS lymphoma: a whole-brain disease? Neurology 2002; 59: 1557–62.
5) Thiel E, Korfel A, Martus P, et al. High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (G-PCNSL-SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol 2010; 11: 1036–47.
6) Weller M, Martus P, Roth P, et al. Surgery for primary CNS lymphoma? Challenging a paradigm. Neuro Oncol 2012; 14: 1481–84.
7) Hoang-Xuan K, Bessell E, Bromberg J, Hottinger AF, Preusser M, Rudà R, Schlegel U, Siegal T, Soussain C, Abacioglu U, Cassoux N, Deckert M, Dirven CM, Ferreri AJ, Graus F, Henriksson R, Herrlinger U, Taphoorn M, Soffietti R, Weller M; European Association for Neuro-Oncology Task Force on Primary CNS Lymphoma. Diagnosis and treatment of primary CNS lymphoma in immunocompetent patients: guidelines from the European Association for Neuro-Oncology. Lancet Oncol. 2015 Jul;16(7):e322-32. doi: 10.1016/S1470-2045(15)00076-5. Review. PubMed PMID: 26149884.

Book: AOSpine Masters Series, Volume 5: Cervical Spine Trauma

AOSpine Masters Series, Volume 5: Cervical Spine Trauma

AOSpine Masters Series, Volume 5: Cervical Spine Trauma

Price: $95.54
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This fifth volume in the AOSpine Masters Series presents a detailed analysis of the essential aspects of managing the most common cervical spine injuries. World-renowned cervical spine experts discuss anatomy, biomechanics, patient evaluation, and critical steps in the decision-making process for the treatment of these complex injuries. Chapters include: Anatomy of the Cervical Spine, Nonoperative Management of Cervical Spine Trauma, and Subaxial Cervical Spine Injuries.
Key Features:

  • Each chapter provides historic literature as well as a synthesized analysis of current literature and proposes an evidence-based treatment plan
  • Editors are international authorities on the management of cervical spine injuries
  • Expert tips and pearls included in every chapter

The AOSpine Masters Series, a copublication of Thieme and AOSpine, a Clinical Division of the AO Foundation, addresses current clinical issues whereby international masters of spine share their expertise and recommendations on a particular topic. The goal of the series is to contribute to an evolving, dynamic model of an evidence-based medicine approach to spine care.
All spine surgeons, orthopaedic surgeons, and neurosurgeons, along with residents and fellows in these areas, will find this book to be an excellent reference that they will consult often in their treatment of patients with cervical spine injuries.


Product Details

  • Published on: 2015-07-30
  • Original language: English
  • Number of items: 1
  • Dimensions: 10.28″ h x .67″ w x 7.24″ l, .0 pounds
  • Binding: Hardcover
  • 146 pages

Today: ASEAN Neuroscience Congress 2015

ASEAN Neuroscience Congress 2015

July 30 — July 31

Singapore


Welcome to the joint meeting of 11th Biennial Convention of the ASEAN Neurological Association and the 16th ASEAN Congress of Neurological Surgery. The congress, hosted by the Clinical Neuroscience Society, Singapore (CNS), will be held in Singapore, from 30 to 31 July 2015.
The congress aims to bring together multidisciplinary fields in Neuroscience to address pertinent up-to date issues in our clinical practice. The field of Neuroscience is rapidly advancing and we are no longer able to treat patients in isolation within our own field of specialty. The face of medicine demands that we work as a multidisciplinary team to provide the best for our patients; it is hence vital for us to be in touch the current issues in Neuroscience and assimilate knowledge into our current practice.
For more information about the congress, please visit http://www.aseanneuroscience2015.sg

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