Non-Hodgkin's lymphoma presenting with spiral cord compression

ABSTRACT

To describe clinical features staging, histology, treatment, functional outcome and survival of 70 patients with histologically confirmed diagnosis of Non Hodgkin's Lymphoma of Epidural Space presenting with spinal cord compression at the outset. Design: A retrospective study of 70 patients of Non Hodgkin's Lymphoma presenting with spinal cord compression seen between March, 1983 and March 1994. Setting: Dept. of Neuro-surgery, Radiotherapy Oncology and Internal medicine of Nishtar Medical College/Hospital Multan. Subjects: Seventy patients out of 825 with biopsy proven diagnosis of Non-Hodgkin's Lymphoma and presenting with spinal cord compression and having stage 1e at initial presentation and treated with chemotherapy [CT] and radiotherapy [RT] after initial decompressive surgery. There were 70 patients with a median age of 35 years. Chronic backache in all the patients and leg weakness [Paraplegia or Severe Paraparesis] in 62 patients were the commonest complaints at the time of initial presentation. 42 patients were non ambulatory. Intermediate grade type was the commonest histology [90% of cases]. Postoperative treatment included Radiotherapy alone in 11 patients, C.T. alone in 22 patients and combination of both Chemotherapy + Radiotherapy [CT + RT] in 37 patients. Out of 70 patients only 23 patients were evaluable for long term follow up and functional results. 13 patients [56%] out of 23 who had combined modality treatment C.T. + R.T. had relapse free median survival of 5 years [0.5-8years] 10 patients out of 23 who either had C.T. alone and RT alone relapsed after a median survival of 2 years [range 0.5-3years]. Functional outcome was better in 13 patients who received combined Chemotherapy + Radiotherapy [CT +RT]. Conclusions: oSpinal Epidural Non-Hodgkin's Lymphoma [S.E.L.] had younger median age i.e. 35 years. This is a significant divergence from reports in the literature. oThere is poor follow-up of patients. oCombined modality treatment i.e. with CT and RT after initial decompressive surgery appears to have improved local control and survival. oLymphoma with involvement of spinal cord should be suspected in cases of spinal cord compression and appropriate neuroimaging be performed to exclude secondary involvement