Stereotactic radiosurgery for the treatment of brain metastases.
BACKGROUND
The objective of this systematic review was to summarise the current evidence concerning radiosurgical treatment (SRS) of newly diagnosed brain metastasis and to compare SRS as a single or additional treatment to treatment alternatives with regard to medical effectiveness and safety.


METHODS
A structured search of electronic databases was performed to identify relevant publications from 2002 through 2007. Studies targeting patients with brain metastases were included. Standardised quality assessment and data extraction were performed.


RESULTS
Of 1496 publications, 16 studies were included. The mean survival in most studies was less than 12 months. There was evidence that SRS plus WBRT was associated with improved local tumour control and neurological functioning compared to either treatment alone. Only in patients with single metastasis, this resulted in improved survival. There was inconclusive evidence when comparing SRS to WBRT, Neurosurgery (NS) or Hypofractionated Radiotherapy (HCSRT). The Quality of life (Qol) was not investigated.


CONCLUSIONS
SRS plus WBRT was associated with improved local tumour control and neurological functioning compared to either treatment alone. Only in certain patients, this resulted in improved survival. Methodologically rigorous studies are therefore warranted to investigate further treatment options, and in view of the poor prognosis, to investigate Qol and neurological functioning.
Müller-Riemenschneider
Falk
F
Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany. falk.mueller-riemenschneider@charite.de
Bockelbrink
Angelina
A
Ernst
Iris
I
Schwarzbach
Christoph
C
Vauth
Christoph
C
von der Schulenburg
J-Matthias Graf
JM
Willich
Stefan N
SN
D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome