Abstract
Primary central nervous system lymphomas (PCNSL) are rare CNS tumors that carry a poor prognosis, with most patients suffering recurrence. Progress has been made in the treatment of this pathology, notably with the widespread use of systemic high dose methotrexate. However, unlike most other malignant CNS neoplasms, surgery for cytoreduction is not routinely performed for this disease, mainly as a result of negative experiences decades ago. Since these studies were published, the availability of intraoperative monitoring, MR imaging and neuro-navigation as well as surgical adjuncts such as fluorescence- guided resection have greatly improved the safety of intracranial procedures. More recent data is suggestive of a potential survival benefit for resection of single PCNSL lesions when patients are subsequently treated with modern regimen high-dose methotrexate, yet this evidence is limited, and should be interpreted conservatively. A systematic review of the literature was performed to identify trials evaluating surgical options for the treatment of PCNSL. In this review, we provide a critical overview of the evidence favoring and discouraging resection for PCNSL. This literature suffers from several biases and limitations that must be considered in the context of the extrapolation of this literature into clinical decision-making.
Highlights
Primary central nervous system lymphomas (PCNSL) are relatively rare non-Hodgkin’s lymphomas, accounting for 1-2% of primary CNS tumors [1]
We provide a critical overview for the evidence supporting and disregarding the role of resection for PCNSL, and offer a rationale for prospective studies to evaluate the safety and efficacy of cytoreductive surgery for this disease
Most of the studies that evaluated the role of resection for PCNSL failed to show a survival benefit from it, and in some cases, have shown considerable morbidity related to surgery (Table 1)
Summary
Primary central nervous system lymphomas (PCNSL) are relatively rare non-Hodgkin’s lymphomas, accounting for 1-2% of primary CNS tumors [1] The treatment of these tumors, consisting of chemotherapy and in some centers radiation, has evolved over the past decades and remains to be fully optimized, with almost all patients suffering recurrence. Unlike most other malignant CNS neoplasms, surgery for cytoreduction is not routinely performed for this disease, mainly as a result of negative experiences decades ago. Since these studies were published, the availability of intraoperative monitoring, MR imaging and neuronavigation as well as surgical adjuncts such as fluorescence- guided resection have greatly improved the safety of intracranial procedures. This literature suffers from several biases and limitations that must be considered in the context of the extrapolation of this literature into clinical decisionmaking
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