Neurologic compression is a disastrous consequence for the patients with primary
non-Hodgkin's lymphoma (NHL) of the spine, and such a condition has not been carefully taken into account in the treatment guidelines. The aim of this study was to compare the effect of
radiotherapy and
chemotherapy alone or combined with
surgical decompression on primary NHL of the spine with neurologic compression. Sixteen patients with primary NHL in the vertebrae of the spine were treated between 1994 and 2006. Thirteen patients had neurologic compression. The
neurologic deficits in 11 patients involved soft tissue extension from the vertebral
tumors and 3 had vertebral fractures with motor signs and 5 had radicular
pain. Five patients were treated by
radiotherapy and
chemotherapy alone while 8 were combined with
surgical decompression. The
decompression operation for
tumors resulted in neurologic recovery in 6 patients. Five patients were not operated on but three received emergent
radiotherapy before
chemotherapy, 4 of whom had complete recovery in their
neurologic symptoms. Of all patients, 3 relapsed. At average follow-up of 61.5 months (range 2-156 months), 4 patients had died after an average interval of 23.3 months from treatment (range 3-71 months). The 5-year overall survival rate was 82% with 60% for the patients in the surgical group, 100% for the patients in the non-surgical group. There was no difference between the groups (chi(2)=3.559, P=0.059). The 5-year overall survival was 100% for the 8 patients who completed CHOP
chemotherapy and
radiotherapy. It appears that optimum treatment in these patients depends on the cause of the
neurologic deficits, whereas the survival is not influenced by the surgical or non-surgical treatment. The results suggest that
chemotherapy and
radiotherapy alone is the ideal treatment for these patients whose neurologic compression was only due to soft tissue extension. The authors emphasize the importance of
chemotherapy and
radiotherapy followed by
surgical decompression depending on individual priorities in the indications for operation on primary NHL of spine with neurologic compression.