A comparative study of interventions in spinal extranodal Non-Hodgkin's lymphoma: A single-center case series from North India

Abstract

Introduction: Non-Hodgkin's lymphoma (NHL) is highly sensitive to chemotherapy and responds to adjuvant chemotherapy within days. Review of literature reveals very limited studies with low statistical significance that compare the surgical and nonsurgical outcomes of spinal NHL. This study aims to compare the surgical and nonsurgical outcomes of spinal extranodal lymphoma causing metastatic spinal cord compression (MSCC). Materials and Methods: We retrospectively analyzed the treatment records of 14 cases out of 32 cases with biopsy-proven diagnosis of NHL involving the spinal column from January 2014 to January 2020. Five (35%) cases were managed nonsurgically with chemotherapy and 9 (64%) patients were managed surgically with adjuvant chemotherapy. Variables taken for evaluation were Karnofsky Performance Status (KPS), Frankel Grade, Spinal Instability Neoplastic Score, Ann Arbor Staging System, and International Prognostic Index (IPI) score. Results: The mean age was 51.9 ± 9.6 years and the median follow-up was 32.5 months. The most study population belonged to Grade III and IV Ann Arbor classification. At final follow-up, 100% of patients in the nonsurgical group and 66% in the surgery group were able to carry out normal activities (KPS >70). All three reported deaths occurred in the intervention group (KPS ≤40) and all deaths occurred within the 6 months of surgery. Conclusion: Primary chemoradiotherapy is mainly indicated in patients of nonemergent mild-to-moderate (Frankel grade >C) neurological deficit patients. Combination therapy (chemotherapy + surgery) is indicated in patients with emergent severe neurological deficit (Frankel Grade A, B, and C), spinal instability, and patients not responding to systemic or adjuvant chemotherapy.