Single-session versus Multi-session Linear Accelerator-based Stereotactic Radiosurgery for Intracranial Meningiomas: A Systematic Review, Meta-Analysis, and Cumulative Meta-analysis
Rama Al-Ammouri1, Bara Hammadeh2, Joud Ayad1, Zaid Muhanna1, Alzahra'a Al matairi1, Salma Nofal1, Ayah Abdulgadir3, Bashar Hatem Mohammad Abualsebaa4, Tariq Al-Saadi5
1University of Jordan, 2Al-Balqa university, 3University of Khartoum, 4Jordan University of Science and Technology, 5Cedars-Sinai Medical Centre
Objective:
To compare tumor volume, functional status, adverse effects, and progression-free survival in meningioma patients treated with single-session versus multi-session radiosurgery.
Background:
Meningiomas comprise one-third of primary intracranial tumors. Stereotactic radiosurgery is a non-surgical radiotherapy technique that delivers focused beams of high-dose radiation while sparing healthy tissue.
Design/Methods:
Relevant articles were retrieved from four databases covering the period from 1980 to 2025. PRISMA guidelines were followed; 29 studies comprising a cohort of 1,517 patients (SS-SRS: 1,040 , MS-SRS: 477 patients ) were included. All analysis were conducted using “meta” package on R version 4.3.3.
Results:
Among 1,517 patients with available outcome data, tumor volume progression was similar for single-session (SS-SRS, 13% [95% CI: 7–23%]) and multi-session SRS (MS-SRS, 10% [5–18%]), p=0.5751. We didn’t observe any statistically significant differences in tumor volume decrease between the two subgroups (SS-SRS: 28% [19–39%]; MS-SRS: 25% [16–37%], p=0.6608). Tumor volume stability was also non-significant: (SS-SRS: 52% [34–69%]; MS-SRS: 73% [59–83%], p=0.0658). Functional outcomes showed no subgroup differences: improvement (SS-SRS: 38% [25–53%]; MS-SRS: 36% [23–51%]), worsening ( SS-SRS: 9% [5–15%]; MS-SRS: 7% [4–10%]), and stability (SS-SRS: 42% [24–65%]; MS-SRS: 63% [53–72%], P = 0.1029). Tumor control rates were high at 5-years for SS-SRS (SS-SRS: 87% [76–93%]; MS-SRS: 82% [54–95%]).
Edema was the most frequently reported adverse effect, occurring in 68 patients treated with single-session radiosurgery, compared to 5 patients in the multi-session group. Heterogeneity was substantial across most analyses. Cumulative meta-analysis revealed stable effect estimates over time, with narrowing confidence intervals in recent studies. Most studies fall within the expected range of sampling variability, with a center clustering of data, and the data was symmetrically distributed; which suggests low risk of publication bias.
Conclusions:
SS-SRS and MS-SRS yield comparable tumor volume and functional outcomes, but MS-SRS may offer higher volume and functional status stability. Both are effective, with selection guided by clinical context
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