gms | German Medical Science

Objective: Treatment of primary central nervous system lymphoma (PCNSL) is still a matter of intense research and clinical studies. Although often included in the treatment regimens (e.g. R-CHOP), the administration of corticosteroids (CS) prior to chemotherapy remains controversial due to a possible “priming” of tumor cells resulting in reduced response to anti-CD20 therapies.

Method: In our department, a total of 54 patients were diagnosed with PCNSL after stereotactic biopsy from 2009 to 2013. Perioperative corticosteroid administration, patient and tumor characteristics, surgical complications, postoperative treatment, histopathological markers, clinical course and outcome were included in the database.

Results: Of the 54 patients, 33 patients (61.1%) received perioperative corticosteroid medication. No differences in both treatment groups were observed with regard to age, gender, time of follow-up, rate of remission or partial remission, CD20 expression, CD45 expression, CD3 expression, tumor staging as assessed by CSF pathology and imaging/bone marrow pathology. No significant differences in imaging parameters as deep-site involvement or multifocal involvement were observed. No significant differences regarding intraoperative complications such as bleeding or postoperative neurological worsening were observed. The histopathological diagnosis of B-Cell PCNSL was obtained in all cases. No significant differences regarding progression-free survival (PFS) (p=0.86) and overall survival (OS) (p=0.79) were observed between both treatment groups. Of the investigated parameters only higher age was associated with reduced PFS (HR=1.36; p<0.05) and OS (HR=1.44; p<0.05).

Conclusions: Our data suggest that perioperative administration of corticosteroids is not associated with altered rates of response to therapy as observed by remission rates. Moreover, no significant differences between PFS and OS were observed in both treatment groups. Hence, administration of perioperative corticosteroids after completion of biopsy might be performed if deemed necessary.