Effectiveness of stereotactic radiosurgery alone or in combination with whole brain radiotherapy compared to conventional surgery and/or whole brain radiotherapy for the treatment of one or more brain metastases: a systematic review and meta-analysis.
OBJECTIVE
To assess the effectiveness of SRS alone or in combination with WBRT compared to surgery and/or WBRT in prolonging survival and improving the quality-of-life and functional status of patients with brain metastases.


METHODS
A meta-analysis of randomized controlled trials and concurrent cohort studies examining SRS versus SRS + WBRT, SRS versus WBRT +/- surgical resection, SRS versus surgical resection only, or SRS + WBRT versus WBRT was conducted. Trial registers, bibliographic databases, and reference lists from selected studies and recent issues of relevant journals were searched. Neuro-oncology specialists were also contacted. All studies were analyzed independently by two reviewers, applying validated critical appraisal techniques.


RESULTS
The review identified three RCTs and one cohort study. Among patients with multiple metastases, no difference in survival between those treated with WBRT + SRS and those treated with WBRT was found. However, in patients with one metastasis, a statistically significant difference, favoring those treated with WBRT + SRS, was observed. Regarding local tumor control at 24 months, rates were significantly higher in the WBRT + SRS treatment arm, regardless of the number of metastases.


CONCLUSIONS
Adding SRS to WBRT improves survival in patients with one brain metastasis. Combining SRS and WBRT improves local tumour control and functional independence in all patients.
Institute of Health Economics, 1200, 10405 Jasper Avenue, Edmonton, Alta., Canada T5J 3N4. tstafinski@ihe.ca
Tania
T
Stafinski
Gian S
GS
Jhangri
Elizabeth
E
Yan
Devidas
D
Menon
D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D006304:Health Status; D006801:Humans; D011788:Quality of Life; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D015983:Selection Bias; D016019:Survival Analysis; D016896:Treatment Outcome