Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials
Background: Brain metastases (BMs) carry a high morbidity and mortality burden. Neoadjuvant stereotactic radiotherapy (NaSRT) has shown promising results. We systematically reviewed the literature on NaSRT for BMs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, Cochrane, and ClinicalTrial.gov were...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/17/4328 |
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| author | Paolo Palmisciano Gianluca Ferini Ramlah Khan Othman Bin-Alamer Giuseppe E. Umana Kenny Yu Aaron A. Cohen-Gadol Tarek Y. El Ahmadieh Ali S. Haider |
| author_facet | Paolo Palmisciano Gianluca Ferini Ramlah Khan Othman Bin-Alamer Giuseppe E. Umana Kenny Yu Aaron A. Cohen-Gadol Tarek Y. El Ahmadieh Ali S. Haider |
| author_sort | Paolo Palmisciano |
| collection | DOAJ |
| description | Background: Brain metastases (BMs) carry a high morbidity and mortality burden. Neoadjuvant stereotactic radiotherapy (NaSRT) has shown promising results. We systematically reviewed the literature on NaSRT for BMs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, Cochrane, and ClinicalTrial.gov were searched following the PRISMA guidelines to include studies and ongoing trials reporting NaSRT for BMs. Indications, protocols, and outcomes were analyzed using indirect random-effect meta-analyses. Results: We included 7 studies comprising 460 patients with 483 BMs, and 13 ongoing trials. Most BMs originated from non-small lung cell carcinoma (41.4%), breast cancer (18.7%) and melanoma (43.6%). Most patients had single-BM (69.8%) located supratentorial (77.8%). Patients were eligible if they had histologically-proven primary tumors and ≤4 synchronous BMs candidate for non-urgent surgery and radiation. Patients with primary tumors clinically responsive to radiotherapy, prior brain radiation, and leptomeningeal metastases were deemed non-eligible. Median planning target volume was 9.9 cm<sup>3</sup> (range, 2.9–57.1), and NaSRT was delivered in 1-fraction (90.9%), 5-fraction (4.8%), or 3-fraction (4.3%), with a median biological effective dose of 39.6 Gy10 (range, 35.7–60). Most patients received piecemeal (76.3%) and gross-total (94%) resection after a median of 1-day (range, 1–10) post-NaSRT. Median follow-up was 19.2-months (range, 1–41.3). Actuarial post-treatment rates were 4% (95%CI: 2–6%) for symptomatic radiation necrosis, 15% (95%CI: 12–18%) and 47% (95%CI: 42–52%) for local and distant recurrences, 6% (95%CI: 3–8%) for leptomeningeal metastases, 81% (95%CI: 75–87%) and 59% (95%CI: 54–63%) for 1-year local tumor control and overall survival. Conclusion: NaSRT is effective and safe for BMs. Ongoing trials will provide high-level evidence on long-term post-treatment outcomes, further compared to adjuvant stereotactic radiotherapy. |
| first_indexed | 2024-03-10T01:57:40Z |
| format | Article |
| id | doaj.art-38c7cd26a3e14fd8b0d3e6893a49fc8c |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T01:57:40Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-38c7cd26a3e14fd8b0d3e6893a49fc8c2023-11-23T12:53:45ZengMDPI AGCancers2072-66942022-09-011417432810.3390/cancers14174328Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical TrialsPaolo Palmisciano0Gianluca Ferini1Ramlah Khan2Othman Bin-Alamer3Giuseppe E. Umana4Kenny Yu5Aaron A. Cohen-Gadol6Tarek Y. El Ahmadieh7Ali S. Haider8Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USADepartment of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, ItalyCollege of Medicine, Texas A&M University, College Station, TX 77843, USADepartment of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USADepartment of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, ItalyDepartment of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USADepartment of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46290, USADepartment of Neurosurgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USADepartment of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USABackground: Brain metastases (BMs) carry a high morbidity and mortality burden. Neoadjuvant stereotactic radiotherapy (NaSRT) has shown promising results. We systematically reviewed the literature on NaSRT for BMs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, Cochrane, and ClinicalTrial.gov were searched following the PRISMA guidelines to include studies and ongoing trials reporting NaSRT for BMs. Indications, protocols, and outcomes were analyzed using indirect random-effect meta-analyses. Results: We included 7 studies comprising 460 patients with 483 BMs, and 13 ongoing trials. Most BMs originated from non-small lung cell carcinoma (41.4%), breast cancer (18.7%) and melanoma (43.6%). Most patients had single-BM (69.8%) located supratentorial (77.8%). Patients were eligible if they had histologically-proven primary tumors and ≤4 synchronous BMs candidate for non-urgent surgery and radiation. Patients with primary tumors clinically responsive to radiotherapy, prior brain radiation, and leptomeningeal metastases were deemed non-eligible. Median planning target volume was 9.9 cm<sup>3</sup> (range, 2.9–57.1), and NaSRT was delivered in 1-fraction (90.9%), 5-fraction (4.8%), or 3-fraction (4.3%), with a median biological effective dose of 39.6 Gy10 (range, 35.7–60). Most patients received piecemeal (76.3%) and gross-total (94%) resection after a median of 1-day (range, 1–10) post-NaSRT. Median follow-up was 19.2-months (range, 1–41.3). Actuarial post-treatment rates were 4% (95%CI: 2–6%) for symptomatic radiation necrosis, 15% (95%CI: 12–18%) and 47% (95%CI: 42–52%) for local and distant recurrences, 6% (95%CI: 3–8%) for leptomeningeal metastases, 81% (95%CI: 75–87%) and 59% (95%CI: 54–63%) for 1-year local tumor control and overall survival. Conclusion: NaSRT is effective and safe for BMs. Ongoing trials will provide high-level evidence on long-term post-treatment outcomes, further compared to adjuvant stereotactic radiotherapy.https://www.mdpi.com/2072-6694/14/17/4328brain metastasesclinical trialsneoadjuvant radiotherapystereotactic radiosurgerystereotactic radiotherapy |
| spellingShingle | Paolo Palmisciano Gianluca Ferini Ramlah Khan Othman Bin-Alamer Giuseppe E. Umana Kenny Yu Aaron A. Cohen-Gadol Tarek Y. El Ahmadieh Ali S. Haider Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials Cancers brain metastases clinical trials neoadjuvant radiotherapy stereotactic radiosurgery stereotactic radiotherapy |
| title | Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials |
| title_full | Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials |
| title_fullStr | Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials |
| title_full_unstemmed | Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials |
| title_short | Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials |
| title_sort | neoadjuvant stereotactic radiotherapy for brain metastases systematic review and meta analysis of the literature and ongoing clinical trials |
| topic | brain metastases clinical trials neoadjuvant radiotherapy stereotactic radiosurgery stereotactic radiotherapy |
| url | https://www.mdpi.com/2072-6694/14/17/4328 |
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