Hypofractionated versus single-fraction stereotactic radiosurgery for the treatment of brain metastases: A systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to synthesize the latest evidence on the hypofractionated stereotactic radiosurgery (HF-SRS) compared to single-fraction stereotactic radiosurgery (SF-SRS) for the treatment of brain metastases. Methods: We systematically searched PubMed, Scopus, EuropePMC, ProQuest, and Cochrane Central Databases. Original research articles investigating patients with brain metastasis receiving HF-SRS or SF-SRS reporting the local control/failure and/or radionecrosis during follow-up were included. Results: There were 1100 patients from 7 studies. 616 lesions were allocated to HF-SRS group and 777 lesions were allocated to SF-SRS group. Pooled rate of local control was 88% (95% CI 84%, 91%) in HF-SRS group and 81% (95% CI 74%, 88%) in the SF-SRS groups. Local control was higher in patients receiving HF-SRS compared to SF-SRS (OR 1.53 [95% CI 1.08, 2.18], p = 0.018; I2: 0%). Pooled rate of radionecrosis was 7% (95% CI 3%, 12%) in HF-SRS group and 15% (95% CI 8%, 23%) in the SF-SRS groups. Similar rate of radionecrosis was observed in both HF-SRS and SF-SRS (OR 0.82 [95% CI 0.31, 2.21], p = 0.698; I2: 61.3%). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) qualification showed a low level of certainty for the higher local control in patients receiving HF-SRS compared to SF-SRS and a very low level of certainty for similar risk of radionecrosis between the two groups. Conclusion: This meta-analysis showed that HF-SRS was associated with higher local control and similar rate of radionecrosis compared to SF-SRS in patients with brain metastases. PROSPERO ID: CRD42020210469

Automated summary

This study found that hypofractionated stereotactic radiosurgery (HF-SRS) resulted in better local control for patients with brain metastases compared to single-fraction stereotactic radiosurgery (SF-SRS), while the rate of radionecrosis was similar between the two treatment groups.