Multimodal Therapy for Localized Spinal Epidural Follicular Lymphoma

Abstract

Background: Myelopathy due to epidural spinal cord compression is rare in patients with malignant lymphoma and most of these patients are diagnosed with high-grade lymphoma. An epidural growth of low-grade lymphoma is even more unusual. Due to this low incidence, therapeutic experience for this entity is limited. Patients and Methods: We report the outcome of 3 consecutive patients with primary spinal epidural follicular lymphoma (FL). Due to the clinical disorders of the patients and despite the localized disease, we used an intensive multimodal therapy concept consisting of spinal decompression, systemic (immuno)chemotherapy and local irradiation. All patients improved in their medical condition; 2 achieved a complete remission, 1 of these with long-term remission. Conclusions: In contrast to the established irradiation therapy for early-stage FL, an intensive multimodal therapy concept should be initiated in patients with primary spinal epidural FL. With this approach, a fast improvement of the symptoms and long-term disease-free survival is possible.

Primary spinal intradural extramedullary lymphoma causing cauda equina syndrome

“…Most authors prefer to administer chemotherapy in conjunction to radiotherapy (RT) and not alone. [1678] Chemotherapy has been given before RT, after RT, sandwiched between, or administered concomitantly with RT. Various combinations of chemotherapeutic agents have been recommended, cyclophosphamide, vincristine, and prednisone being an integral part of all the combinations.…”

An Unusual Instrumentation-Related S1 Radiculopathy in a Patient Treated for a Primary Vertebral (L3) Lymphoma

“…For example, many researchers have sustained that in case of spinal cord or nerve roots compression, a surgical procedure of posterior decompressive laminectomy and stabilization followed by adjuvant local radiotherapy and chemotherapy (CHOP-based chemotherapy) is mandatory. 1,2,27,29,30…”

“…For example, many researchers have sustained that in case of spinal cord or nerve roots compression, a surgical procedure of posterior decompressive laminectomy and stabilization followed by adjuvant local radiotherapy and chemotherapy (CHOP-based chemotherapy) is mandatory. 1,2,27,29,30 Other researchers have reported that the sole combination of chemo and radiotherapy, without any surgical procedure, could rapidly reduce compression of the involved neurologic structures. This is even recommended in cases of spinal cord compression by pathologic tissue.…”

Primary spinal epidural lymphomas

“…[11553] Monnard et al observed local control of 88% and a 5-year overall survival of 69% with combined modality treatment. Among the 20 patients who received RT alone, 11 suffered a systemic relapse, 7 died, and 4 were alive of which 2 still had disease.…”