Stereotactic Radiosurgery for Central Nervous System Lymphoma: A Systematic Review and Meta-Analysis Publisher



Hajikarimloo B ; Mohammadzadeh I ; Tos SM ; Mortezaei A ; Alvani MS ; Kooshki A ; Habibi MA
Source: Acta Neurologica Belgica Published:2026

Abstract

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. © The Author(s) under exclusive licence to Belgian Neurological Society 2026.