Clinical Characteristics, Treatment Strategies, and Outcomes of Diffuse Large B-Cell Lymphoma Involving the Sciatic Nerve: A Systematic Review
Othman Bin-Alamer1, Kiran Sankarappan2, Kishore Balasubramanian2, Abdurrahman Kharbat3
1Loma Linda University Medical Center, 2Texas A&M University College of Medicine, 3University of Oklahoma Health Sciences Center
Objective:
To systematically review the clinical presentation, management, and outcomes of diffuse large B-cell lymphoma (DLBCL) involving the sciatic nerve.
Background:
DLBCL is an aggressive non-Hodgkin lymphoma with a tendency for extranodal involvement. Sciatic nerve involvement is rare but can lead to significant neurological deficits, including pain, weakness, and sensory disturbances. Although there is currently no standard of care for DLBCL with peripheral nerve involvement, treatment typically follows R-CHOP chemotherapy, with radiotherapy for residual or localized disease.
Design/Methods:
A systematic review was conducted according to PRISMA guidelines. Databases including PubMed, Web of Science, and Cochrane were searched, and 16 articles covering 17 patients with sciatic nerve involvement were analyzed.
Results:
The average age of patients was 62.88 years, including 6 males (35%) and 11 females (65%). Presenting symptoms included lower extremity pain (28%), weakness (15%), and paresthesias (10%), with an average symptom duration of 9.85 months. MRI was performed in all patients and FDG-PET in 9, revealing masses involving various points of the sciatic nerve. The average tumor length was 8.23 cm. Sciatic nerve biopsy was performed in 65% of patients, with CD20 positivity in all tested cases.
Chemotherapy was the primary treatment for 94% of cases, with 24% undergoing surgical resection. Sciatic nerve sacrifice occurred in only one case. Adjuvant radiotherapy was administered in 53%. At last follow-up, 44% of patients improved neurologically, while 31% worsened. Recurrence occurred in 35% of patients, 67% of whom experienced declining neurological function, with a 75% mortality rate in this group. Overall, 76% of patients were alive at last follow-up.
Conclusions:
DLBCL involving the sciatic nerve predominantly affects older adults, presenting with various neurological symptoms. Management typically involves chemotherapy and radiotherapy, but recurrence remains common and is associated with a high mortality rate, highlighting the need for further research to improve outcomes.
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