Efficacy and Safety of Stereotactic Radiosurgery Versus Whole Brain Radiotherapy for the Management of Brain Metastasis: A Systematic Review and Meta-analysis
Shrouk Mohamed1, Emad D. Singer2, Hebatalla M. Farouk3, Abdelrahman Youssef4, Mohamed Elmallahy5, Hazem Ghaith6, Amr Moursi7, Ahmed Negida8
1Alexandria University, 2The University of Texas MD Anderson Cancer Center, 3Faculty of Medicine, Fayoum University, 4Minia University Faculty of Medicine, 5Faculty of Medicine, Tanta University, 6Faculty of Medicine, Al-Azhar University, 7Neurosurgery Research fellow at Hull university teaching hospitals NHS trust, 8Virginia Commonwealth University
Objective:
The primary objective of this review is to provide a comprehensive synthesis of the existing high-quality evidence that compares the outcomes of WBRT and SRS for the management of brain metastases.
Background:
Whole-brain radiotherapy (WBRT) has historically been the first choice for most patients with brain metastasis (BMs), despite its adverse effects on patients’ general health. Recently, stereotactic radiosurgery (SRS) has emerged as a safe and effective potential alternative for patients with BMs.
Design/Methods:
We searched electronic databases such as PubMed, Scopus, WOS, and Cochrane CENTRAL for relevant comparative studies comparing SRS and WBRT for BMs. Eligible studies were selected, and their data were extracted from a uniform data extraction sheet and analyzed using the RevMan software (version 5.2).
Results:
Thirty-five studies (n= 26 observational and n= 9 RCTs) were included in this meta-analysis (total n = 26000 patients). SRS was associated with longer survival time (MD 4.38 months, 95% CI [3.09, 6.56], P < 0.00001); however, this difference was mainly driven by the retrospective studies, and evidence from 2 RCTs showed comparable survival times. SRS was associated with a longer time to intracranial progression (SMD -0.94, 95% CI [-1.64, -0.23], P = 0.009) and better local intracranial control (RR 1.20, 95% CI [1.01, 1.42], P = 0.04). SRS showed no significant difference in distant intracranial control compared to WBRT (OR 0.61, 95% CI [0.32, 1.19], P = 0.15). There were significant differences between the two arms regarding adverse events associated with WBRT, such as headache, vomiting, motor dysfunction, radiation necrosis, and fatigue.
Conclusions:
SRS has been associated with better survival and local tumor control. It is a safer procedure that enhances short-term quality of life and preserves cognitive function in the long term. Thus, SRS alone is a suitable recommendation for patients at a high risk of neurocognitive decline.