title: Stereotactic radiosurgery for the treatment of brain metastases.
abstract: 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.
authors.affiliation: Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany. falk.mueller-riemenschneider@charite.de
authors.forename: Falk
authors.initials: F
authors.lastname: Müller-Riemenschneider
authors.forename: Angelina
authors.initials: A
authors.lastname: Bockelbrink
authors.forename: Iris
authors.initials: I
authors.lastname: Ernst
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwarzbach
authors.forename: Christoph
authors.initials: C
authors.lastname: Vauth
authors.forename: J-Matthias Graf
authors.initials: JM
authors.lastname: von der Schulenburg
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome