Efficacy of stereotactic radiosurgery as single or combined therapy for brain metastasis: A systematic review and meta-analysis

To determine the efficacy of stereotactic radiosurgery (SRS) in treating patients with brain metastases (BMs), a network meta-analysis (NMA) of randomized controlled trials (RCTs) and a direct comparison of cohort studies were performed. Relevant literature regarding the effectiveness of SRS alone and in combination with wholebrain radiotherapy (WBRT) and surgery was retrieved using systematic database searches up to April 2019. The patterns of overall survival (OS), one-year OS, progression-free survival (PFS), one-year local brain control (LBC), one-year distant brain control (DBC), neurological death (ND), and complication rate were analyzed. A total of 18 RCTs and 37 cohorts were included in the meta-analysis. Our data revealed that SRS carried a better OS than SRS+WBRT (p = 0.048) and WBRT (p = 0.041). Also, SRS+WBRT demonstrated a significantly improved PFS, LBC, and DBC compared to WBRT alone and SRS alone. Finally, SRS achieved the same LBC as high as surgery, but intracranial relapse occurred considerably more frequently in the absence of WBRT. However, there were not any significant differences in ND and toxicities between SRS and other groups. Therefore, SRS alone may be a better alternative since increased patient survival may outweigh the increased risk of brain tumor recurrence associated with it.

Automated summary

A network meta-analysis and direct comparison of cohort studies were conducted to evaluate the efficacy of stereotactic radiosurgery (SRS) in treating brain metastases (BMs). The results showed that SRS had better overall survival (OS) compared to SRS+whole-brain radiotherapy (WBRT) and WBRT alone. SRS+WBRT also demonstrated improved progression-free survival (PFS), local brain control (LBC), and distant brain control (DBC) compared to WBRT alone and SRS alone. However, there were no significant differences in neurological death (ND) and complications between SRS and other treatment groups. Therefore, SRS alone may be a preferable alternative.