Primary non-Hodgkin's lymphoma of the spine with neurologic compression treated by radiotherapy and chemotherapy alone or combined with surgical decompression

Neurologic compression is a disastrous consequence for the patients with primary non-Hodgkin's lymphoma (NHL) of the spine, and such a condition has not been carefully taken into account in the treatment guidelines. The aim of this study was to compare the effect of radiotherapy and chemotherapy alone or combined with surgical decompression on primary NHL of the spine with neurologic compression. Sixteen patients with primary NHL in the vertebrae of the spine were treated between 1994 and 2006. Thirteen patients had neurologic compression. The neurologic deficits in 11 patients involved soft tissue extension from the vertebral tumors and 3 had vertebral fractures with motor signs and 5 had radicular pain. Five patients were treated by radiotherapy and chemotherapy alone while 8 were combined with surgical decompression. The decompression operation for tumors resulted in neurologic recovery in 6 patients. Five patients were not operated on but three received emergent radiotherapy before chemotherapy, 4 of whom had complete recovery in their neurologic symptoms. Of all patients, 3 relapsed. At average follow-up of 61.5 months (range 2-156 months), 4 patients had died after an average interval of 23.3 months from treatment (range 3-71 months). The 5-year overall survival rate was 82% with 60% for the patients in the surgical group, 100% for the patients in the non-surgical group. There was no difference between the groups (χ2=3.559, P=0.059). The 5-year overall survival was 100% for the 8 patients who completed CHOP chemotherapy and radiotherapy. It appears that optimum treatment in these patients depends on the cause of the neurologic deficits, whereas the survival is not influenced by the surgical or non-surgical treatment. The results suggest that chemotherapy and radiotherapy alone is the ideal treatment for these patients whose neurologic compression was only due to soft tissue extension. The authors emphasize the importance of chemotherapy and radiotherapy followed by surgical decompression depending on individual priorities in the indications for operation on primary NHL of spine with neurologic compression.