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Stereotactic radiosurgery for central nervous system lymphoma: a systematic review and meta-analysis
Bardia Hajikarimloo1, Ibrahim Mohammadzadeh2, Salem M Tos3
1Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA. bardii47@yahoo.com.
Background:
Central nervous system lymphomas (CNSL) are aggressive and rare malignancies that are associated with a poor prognosis and limited treatment options. While high-dose methotrexate (HD-MTX) and whole-brain radiotherapy (WBRT) are primary options, they are correlated with recurrence and neurotoxicity. Stereotactic radiosurgery (SRS) has emerged as a potential targeted option; however, its effectiveness in CNSL remains largely unexplored. This study aimed to evaluate the role of SRS in CNSLs.
Methods:
A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science. Studies reporting local control (LC), progression-free survival (PFS), overall survival (OS), distant brain failure (DBF), and adverse radiation effects (ARE) were included.
Results:
Sixteen studies involving 321 patients and 462 lesions were analyzed. The pooled LC was 97% (95% CI: 94%-100%), and the DBF rate was 58% (95% CI: 43%-72%). The PFS at 6, 12, and 24 months was 75% (95% CI: 67%-83%), 54% (95% CI: 44%-63%), and 29% (95% CI: 13%-48%), while the OS was 90% (95% CI: 78%-98%), 73% (95% CI: 56%-88%), and 42% (95% CI: 26%-59%). The pooled ARE rate was 7% (95% CI: 4%-11%). Human immunodeficiency virus (HIV)-positive status and larger tumor size were associated with less favorable outcomes.
Conclusion:
SRS is associated with promising clinical and radiologic outcomes and low ARE rates in patients with CNSL, serving as a complementary or salvage option.
