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Ryo Nishikawa, Resection of PCNSL, if safely possible, seems to be better than biopsy: challenging a paradigm?, Neuro-Oncology, Volume 14, Issue 12, December 2012, Page 1423, https://doi.org/10.1093/neuonc/nos293
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A subanalysis of the German randomized phase III study, G-PCNSL-SG-1, which evaluated the role of whole brain radiotherapy in the treatment of newly diagnosed primary CNS lymphoma (PCNSL), revealed that biopsied patients had inferior PFS and OS than did both gross totally and subtotally resected patients.1 If this is true, it will change the paradigm, as the authors suggest that neurosurgeons have long believed that resection of PCNSL is not necessary.
It is also believed that an attempted total or subtotal resection of germinomas is unnecessary as well because these tumors are highly sensitive to chemotherapy and radiotherapy.2 Germinomas become smaller even after diagnostic computed tomography scans, and 90% of patients are cured by chemo-radiotherapy. PCNSL is also sensitive to chemotherapy and radiotherapy as almost 50% of patients achieve a complete response after chemoradiotherapy.
On the other hand, although non-germinomatous germ cell tumors and medulloblastomas are relatively sensitive to chemotherapy or radiotherapy compared to other malignant brain tumors, such as gliomas, total resection at some time point is definitely beneficial to cure patients.
