Assessing the Safety of Craniotomy for Resection of Primary Central Nervous System Lymphoma: A Nationwide Inpatient Sample Analysis

Abstract

BackgroundUnlike many other central nervous system (CNS) tumors, the surgical management of primary central nervous system lymphomas (PCNSL) is traditionally limited by diagnostic biopsy. Studies that predate the use of modern neurosurgical techniques have reported a prohibitive operative morbidity for this surgery. These early experiences have dictated the non-surgical management of PCNSL, whereas resection for cytoreduction is a mainstay of treatment in other CNS malignancies. Recent studies have suggested that craniotomy with the goal of cytoreduction might be associated with a favorable overall and progression-free survival for some patients with PCNSL. To challenge the traditional non-surgical paradigm, it is essential to first investigate the safety of resection for PCNSL.MethodsTo determine the operative morbidity of resection for this disease, we performed a population-based assessment of complications using the nationwide inpatient sample database for the years 1998–2013 for biopsies and open craniotomies for PCNSL and other brain tumors.ResultsAmong 95 patients who underwent biopsy and 34 patients who underwent craniotomy, we found no significant difference in complication rates between craniotomy for resection and biopsy procedures for PCNSL (23.16 versus 20.59%). The types of complications differ between diagnoses, with the PCNSL cohort suffering mainly medical complications and the non-PCNSL cohort suffering mainly from neurological complications.ConclusionThese findings support the safety of craniotomies in PCNSL and help provide a rationale for future prospective studies to evaluate the safety and efficacy of resection for this disease.

Is It Time to Remove Radiotherapy in the Management of Primary Central Nervous System Lymphoma? Population-based Study, Pool-Analysis and Retrospective Study of Recurrence Pattern.

“…To better understand the pattern and mechanism of relapse, we reviewed 27 relapsed patients who attained complete response (CR), partial response (PR) or stable disease (SD) during or after first-line treatment without WBRT for newly diagnosed PCNSL in our institution. We found more than half of the patients had distant recurrence and among those reached CR patients, 9/11(82%)had distant recurrence as well, which are comparable to those described with intravenous HD-MTX (12/16, 75%) 33 and those with intra-arterial HD-MTX in conjunction with blood-brain barrier disruption (BBBD) 50 (30/37, 80%).Recently, a number of studies [51][52][53][54][55] have shown that surgery may be beneficial for PCNSL patients. It is worth noting that 8 of the 11patients who achieved CR by receiving GTR, eventually relapsed with DR, which reminds us that there may be subclinical CNS lymphomas which contrast enhanced MRI cannot to detect.…”

Surgical resection versus biopsy in the treatment of primary central nervous system lymphoma: a systematic review and meta-analysis

“…This indicates a potential selection bias, which might contribute to the observed differences in the outcomes between the resection group and the biopsy group, confounding the results. The complication rates for surgical resection and biopsy seem to be comparable [40,41]. Cloney et al [40] concluded that surgical resection of PCNSL is safe for selected patients and that the complication rate is comparable to that of other intracranial neoplasms.…”

Clinical Impact of the Histopathological Index and Neuroimaging Features Status in Primary Central Nervous System Diffuse Large B-Cell Lymphoma: A Single-Center Retrospective Analysis of 51 Cases

“…However, in our study, the extent of resection may correlate with PFS. Technical advances in neurosurgery have increased the safety of PCNSL surgical resections (13,14). Therefore, we propose reconsidering tumor removal to treat a single lesion amenable to resection.…”