Surgery plus adjuvant radiotherapy for primary central nervous system lymphoma

Area of Science:

• Neuro-oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Recent studies indicate cytoreductive surgery improves survival in primary central nervous system lymphoma (PCNSL).
• The role of adjuvant treatment following surgery in PCNSL remains under-investigated.
• This study examines the survival outcomes of PCNSL patients treated with surgery and radiation therapy (RT).

Purpose of the Study:

• To investigate the survival benefits of adjuvant radiation therapy (RT) in patients with primary central nervous system lymphoma (PCNSL) who have undergone surgery.
• To compare survival rates between different treatment modalities including biopsy alone, biopsy plus RT, surgery alone, and surgery plus RT.
• To analyze the impact of RT on survival based on the extent of surgical resection and patient age.

Main Methods:

• Retrospective analysis of 5417 PCNSL cases from the Surveillance, Epidemiology, and End-Results (SEER) Program (1995-2013).
• Comparison of survival outcomes across treatment groups: biopsy alone, biopsy + RT, surgery alone, and surgery + RT.
• Multivariable analysis was used to assess the relationship between treatment, prognostic factors, and survival, including cause-specific survival.

Main Results:

• Surgery plus RT was associated with significantly improved survival compared to surgery alone (HR=0.58).
• Adjuvant RT improved survival irrespective of resection extent (subtotal: HR=0.62, gross-total: HR=0.54 for surgery+RT).
• Survival benefits of adjuvant RT were observed in both younger and older PCNSL patient groups.

Conclusions:

• Adjuvant radiation therapy (RT) is associated with improved survival in primary central nervous system lymphoma (PCNSL) patients following surgical intervention.
• These findings suggest RT is a beneficial addition to surgical treatment for PCNSL.
• Further research is needed to optimize post-operative RT strategies, considering neurotoxicity, dosage, and chemotherapy.