A Babylonian Perspective on Greek Medicine

Between 1971 and 1988, 20 patients with previously undiagnosed non-Hodgkin's lymphoma (NHL), of intermediate or high grade histology presented with extradural spinal cord compression. All had decompressive surgery. The first treatment after surgery was chemotherapy in nine and radiotherapy in 11 patients. At presentation 15% were ambulant and this improved to 55% after surgery; urinary continence improved from 30 to 80%. Mobility and sphincter control remained unchanged, regardless of subsequent therapy. Chemotherapy as the initial treatment modality after surgery, either alone or in combination with radiotherapy, did not jeopardise functional outcome. Mobility after surgery was an independent prognostic factor for survival, when corrected for age and stage at presentation (P = 0.04). The treatment of intermediate and high grade NHL presenting with spinal cord compression should be based on histology, extent of disease and age, as with other sites of presentation, but should also take into consideration the prognostic importance of post-surgical mobility. Non-Hodgkin's lymphoma (NHL) presenting with spinal cord compression (SCC) has traditionally been treated by decompressive surgery followed by local radiotherapy Localised treatment at the site of cord compression after surgery, was considered to give the best chance of local control and therefore the best functional result. Chemotherapy is the treatment of choice in advanced aggressive histology NHL and also in localised presentations, since it treats subclinical metastatic disease (Connors et al. It would also be considered as the first treatment after decompressive surgery, in NHL presenting with spinal cord compression, provided the functional outcome was not jeopardised. We reviewed the results of therapy in patients presenting with SCC due to previously undiagnosed NHL. All had initial decompressive laminectomy followed by either chemotherapy, radiotherapy or combined modality therapy. Analysis by functional outcome as well as survival provides a rational basis for treatment strategies in this unusual presentation of NHL. Patients and methods Between 1971 and 1988, 20 patients with extradural spinal cord compression due to previously undiagnosed NHL were referred to The Royal Marsden Hospital for further staging and therapy. Histology was reviewed in all patients and was of intermediate grade in 15 and high grade in five (NCI Working Formulation, 1982). The level of cord compression was assessed prior to surgery by myelography in all but one patient, in whom the clinical level correlated with the verte-bral collapse on plain X-ray. Following surgery all patients underwent staging investigations which included baseline haematology and biochemistry, chest X-ray, bone …