Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis
Objective: The standard of care in patients with solitary brain metastasis involves surgical resection and postoperative whole-brain radiotherapy (WBRT). However, WBRT is associated with adverse effects, mainly neurocognitive deterioration. Stereotactic radiosurgery (SRS) is a more targeted form of...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-04-01
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| Series: | World Neurosurgery: X |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139723000194 |
| _version_ | 1797850209282162688 |
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| author | Nikolaos Vlachos Marios G. Lampros Panagiotis Filis Spyridon Voulgaris George A. Alexiou |
| author_facet | Nikolaos Vlachos Marios G. Lampros Panagiotis Filis Spyridon Voulgaris George A. Alexiou |
| author_sort | Nikolaos Vlachos |
| collection | DOAJ |
| description | Objective: The standard of care in patients with solitary brain metastasis involves surgical resection and postoperative whole-brain radiotherapy (WBRT). However, WBRT is associated with adverse effects, mainly neurocognitive deterioration. Stereotactic radiosurgery (SRS) is a more targeted form of radiation therapy that could be as effective as WBRT without the detrimental neurocognitive decline. Methods: We performed the first systematic review and meta-analysis comparing postoperative SRS versus postoperative WBRT in patients with one resected brain metastasis. PubMed, Scopus, and Cochrane library were systematically searched for studies comparing the efficacy of the two radiation modalities in terms of local and distant brain control, leptomeningeal disease control, and overall survival. Additionally, we extracted patients’ neurocognitive function and quality of life after each postoperative radiation form. Results: Four studies with 248 patients (128: WBRT, 120: SRS) were included in our analysis. There was no difference between SRS and WBRT in the risk of local recurrence (RR = 0.92, CI = 0.51–1.66, p = 0.78, I2 = 0%) and leptomeningeal disease (RR = 1.21, CI = 0.49–2.98, p = 0.67, I2 = 18%), neither in the patients’ overall survival (HR = 1.06, CI = 0.61–1.85, p = 0.83, I2 = 63%). Nevertheless, SRS appeared to increase the risk of distant brain failure (RR = 2.03, CI = 0.94–4.40, p = 0.07, I2 = 61%). Neurocognitive function and quality of life in the SRS group were equal or superior to the WBRT group. Conclusions: Although SRS may increase the risk of distant brain failure, it appears to be as effective as WBRT in terms of local control, risk of leptomeningeal disease, and overall survival while sparing the patients of the detrimental, WBRT-associated cognitive deterioration. |
| first_indexed | 2024-04-09T18:57:47Z |
| format | Article |
| id | doaj.art-0c7e4950a8ac4505ae079038940565e2 |
| institution | Directory Open Access Journal |
| issn | 2590-1397 |
| language | English |
| last_indexed | 2024-04-09T18:57:47Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj.art-0c7e4950a8ac4505ae079038940565e22023-04-09T05:49:57ZengElsevierWorld Neurosurgery: X2590-13972023-04-0118100170Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysisNikolaos Vlachos0Marios G. Lampros1Panagiotis Filis2Spyridon Voulgaris3George A. Alexiou4Department of Neurosurgery, University Hospital of Ioannina, Ioannina, GreeceDepartment of Neurosurgery, University Hospital of Ioannina, Ioannina, GreeceDepartment of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece; Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110, Ioannina, GreeceDepartment of Neurosurgery, University Hospital of Ioannina, Ioannina, GreeceDepartment of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece; Corresponding author.Objective: The standard of care in patients with solitary brain metastasis involves surgical resection and postoperative whole-brain radiotherapy (WBRT). However, WBRT is associated with adverse effects, mainly neurocognitive deterioration. Stereotactic radiosurgery (SRS) is a more targeted form of radiation therapy that could be as effective as WBRT without the detrimental neurocognitive decline. Methods: We performed the first systematic review and meta-analysis comparing postoperative SRS versus postoperative WBRT in patients with one resected brain metastasis. PubMed, Scopus, and Cochrane library were systematically searched for studies comparing the efficacy of the two radiation modalities in terms of local and distant brain control, leptomeningeal disease control, and overall survival. Additionally, we extracted patients’ neurocognitive function and quality of life after each postoperative radiation form. Results: Four studies with 248 patients (128: WBRT, 120: SRS) were included in our analysis. There was no difference between SRS and WBRT in the risk of local recurrence (RR = 0.92, CI = 0.51–1.66, p = 0.78, I2 = 0%) and leptomeningeal disease (RR = 1.21, CI = 0.49–2.98, p = 0.67, I2 = 18%), neither in the patients’ overall survival (HR = 1.06, CI = 0.61–1.85, p = 0.83, I2 = 63%). Nevertheless, SRS appeared to increase the risk of distant brain failure (RR = 2.03, CI = 0.94–4.40, p = 0.07, I2 = 61%). Neurocognitive function and quality of life in the SRS group were equal or superior to the WBRT group. Conclusions: Although SRS may increase the risk of distant brain failure, it appears to be as effective as WBRT in terms of local control, risk of leptomeningeal disease, and overall survival while sparing the patients of the detrimental, WBRT-associated cognitive deterioration.http://www.sciencedirect.com/science/article/pii/S2590139723000194Whole-brain radiotherapyStereotactic radiosurgeryBrain metastasisOverall survivalNeurocognitive function |
| spellingShingle | Nikolaos Vlachos Marios G. Lampros Panagiotis Filis Spyridon Voulgaris George A. Alexiou Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis World Neurosurgery: X Whole-brain radiotherapy Stereotactic radiosurgery Brain metastasis Overall survival Neurocognitive function |
| title | Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis |
| title_full | Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis |
| title_fullStr | Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis |
| title_full_unstemmed | Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis |
| title_short | Stereotactic radiosurgery versus whole-brain radiotherapy after resection of solitary brain metastasis: A systematic review and meta-analysis |
| title_sort | stereotactic radiosurgery versus whole brain radiotherapy after resection of solitary brain metastasis a systematic review and meta analysis |
| topic | Whole-brain radiotherapy Stereotactic radiosurgery Brain metastasis Overall survival Neurocognitive function |
| url | http://www.sciencedirect.com/science/article/pii/S2590139723000194 |
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