Impact of Multimodal Therapy on the Treatment of Pediatric Patients with Central Nervous System Lymphoma: Preliminary Results of a Scoping Review.

Abstract

Background. Central nervous system (CNS) involvement in pediatric patients with lymphoma is an uncommon manifestation associated with neurological complications that may compromise functionality, independence, and quality of life. Timely diagnosis and appropriate treatment are essential to reduce sequelae and promote comprehensive rehabilitation. Objective. To determine the impact of multimodal therapy on the treatment of pediatric patients with central nervous system lymphoma according to published studies. Methodology. A search was conducted in PubMed using the following terms: (Child OR Children) AND (Lymphoma OR Lymphomas) AND (“Central Nervous System”) AND (“Combined Modality Therapy”). Observational studies, case series, and case reports describing pediatric patients with lymphoma and CNS involvement were included. Study selection was performed in duplicate in two stages: title/abstract screening and full-text review. A narrative synthesis was conducted considering population characteristics, diagnostic methods, treatment, remission, survival, prognostic factors, and functional outcomes. Results. A total of 25 articles were identified, and 13 were included. Diagnosis was mainly performed using magnetic resonance imaging, computed tomography, cerebrospinal fluid analysis, biopsy, and immunohistochemistry. The predominant therapeutic strategy consisted of systemic chemotherapy combined with radiotherapy directed to the CNS or affected lesions; some studies also evaluated intrathecal prophylaxis and treatment regimens with reduced cranial irradiation. Remission and survival rates were variable, with better outcomes observed in patients diagnosed and treated early. The main prognostic factors identified were clinical stage, systemic extension, timing of neurological involvement, histological subtype, and initial response to treatment. In patients who achieved remission, partial or complete recovery of neurological deficits was reported, with improvement in motor, sensory, visual, and sphincter-related symptoms. In contrast, advanced disease and systemic recurrence were associated with greater functional deterioration and lower survival. Conclusions. The available evidence suggests that multimodal therapy based on chemotherapy and radiotherapy is associated with higher remission rates, improved survival, and functional recovery in pediatric patients with lymphoma and CNS involvement. However, neurological relapse and advanced disease remain associated with poorer clinical and functional outcomes. Higher-quality methodological studies are required to define the impact of different therapeutic modalities on functionality and comprehensive rehabilitation.