Peng Xinsheng, Wan Yong, Chen Yingming, Chen Liyan, He Aishan, Liao Weiming, Shen Jingnan, Fu Qizhen, Han Shiying, Li Fobao, Zou Xuenong
Department of Orthopaedic Surgery, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong Province, PR China.
Oncol Rep. 2009 May;21(5):1269-75. doi: 10.3892/or_00000350.
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 (chi(2)=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.
神经受压是原发性脊柱非霍奇金淋巴瘤（NHL）患者的灾难性后果，而这种情况在治疗指南中并未得到充分考虑。本研究的目的是比较单独放疗和化疗或联合手术减压对伴有神经受压的原发性脊柱NHL的疗效。1994年至2006年间，对16例原发性脊柱椎体NHL患者进行了治疗。其中13例患者存在神经受压。11例患者的神经功能缺损涉及椎体肿瘤的软组织延伸，3例因椎体骨折出现运动体征，5例有神经根性疼痛。5例患者仅接受放疗和化疗，8例联合手术减压。肿瘤减压手术使6例患者神经功能恢复。5例患者未接受手术，但3例在化疗前接受了急诊放疗，其中4例神经症状完全恢复。所有患者中，3例复发。平均随访61.5个月（范围2 - 至156个月），4例患者在治疗后平均23.3个月（范围3 - 71个月）死亡。5年总生存率为82%，手术组患者为60%，非手术组患者为100%。两组之间无差异（χ² = 3.559，P = 0.059）。完成CHOP化疗和放疗的8例患者5年总生存率为100%。这些患者的最佳治疗似乎取决于神经功能缺损的原因，而生存率不受手术或非手术治疗的影响。结果表明，对于神经受压仅由软组织延伸引起的患者，单独化疗和放疗是理想的治疗方法。作者强调，对于伴有神经受压的原发性脊柱NHL患者，应根据手术指征的个体优先级，先进行化疗和放疗，然后再进行手术减压。
