Comparison of Surgical Resection and Stereotactic Radiosurgery in the Initial Treatment of Brain Metastasis

Liu, Zhen; He, Shu-Ting; Liang, Li

doi:10.1159/000509319

Cited by 6 publications

(3 citation statements)

References 42 publications

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“…We found a low level of evidence suggesting that RS alone and surgery followed by WBRT may provide an equal local PFS. This finding replicates the previous results of Liu et al, who conducted a quantitative synthesis with level-III evidence that was flawed by including retrospective and prospective observational studies and insufficiently strict inclusion criteria [32]. Furthermore, our study found no differences in OS among RS and surgical resection groups.…”

Section: Applicability and Relevance Of The Evidencesupporting

confidence: 89%

Surgery vs. Radiosurgery for Patients with Localized Metastatic Brain Disease: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Fiore

Tariciotti

Bertani

et al. 2023

Cancers

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Purpose: To analyze the efficacy and safety of surgery compared to radiosurgery (RS), combined or not with whole brain radiotherapy (WBRT), for localized metastatic brain disease. Methods: A systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The inclusion criteria were limited to randomized controlled trials (RCTs) that compared surgery and RS for patients with up to 3 metastases (median diameter ≤ 4 cm). The primary outcomes were represented by overall survival (OS) and local brain progression-free survival (PFS), with the rate of complications as a secondary outcome. The pooled estimates were calculated using random forest models. The risk of bias was evaluated using the RoB2 revised tool and the certainty of the evidence was assessed according to the GRADE guidelines. Results: In total, 11,256 records were identified through database and register searches. After study selection, 3 RCTs and 353 patients were included in the quantitative synthesis. Surgery and RS represented the main intervention arms in all the included RCTs. Conclusions: A low level of evidence suggests that RS alone and surgery followed by WBRT provide an equal rate of local brain PFS in patients with localized metastatic brain disease. There is a very low level of evidence that surgery and RS as main interventions offer equivalent OS in the population investigated. A reliable assessment of the complication rates among surgery and RS was not achievable. The lack of high-certainty evidence either for superiority or equivalence of these treatments emphasizes the need for further, more accurate, RCTs comparing surgery and RS as local treatment in patients with oligometastatic brain disease.

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Section: Applicability and Relevance Of The Evidencesupporting

confidence: 89%

Surgery vs. Radiosurgery for Patients with Localized Metastatic Brain Disease: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Fiore

Tariciotti

Bertani

et al. 2023

Cancers

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“…This effect was not detected in a recent meta-analysis of studies with one or more metastases of unrestricted diameter. 46 Indeed, by excluding any study that did not meet the criteria of a median number of brain metastases ≤4 with a median diameter ≤4 cm, we extracted an incidence of recurrence that may have been previously lost in the heterogeneity of disparate tumor sizes and number of metastases.…”

Section: Discussionmentioning

confidence: 99%

Management of brain metastasis. Surgical resection versus stereotactic radiotherapy: a meta-analysis

Krist

Naik

Thompson

et al. 2022

Neuro-Oncology Advances

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Background Treatment of metastatic brain tumors often involves radiotherapy with or without surgical resection as the first step. However, the indications for when to use surgery are not clearly defined for certain tumor sizes and multiplicity. This study seeks to determine whether resection of brain metastases versus exclusive radiotherapy provided improved survival and local control in cases where metastases are limited in number and diameter. Methods According to PRISMA guidelines, this meta-analysis compares outcomes from treatment of a median number of brain metastases ≤4 with a median diameter ≤4 cm with exclusive radiotherapy versus surgery followed by radiotherapy. Four randomized control trials and 11 observational studies (1693 patients) met inclusion criteria. For analysis, studies were grouped based on whether radiation involved stereotactic radiosurgery (SRS) or whole-brain radiotherapy (WBRT). Results In both analyses, there was no difference in survival between surgery ±SRS versus SRS alone two years after treatment (OR 1.89 (95% CI: 0.47 - 7.55, p = 0.23) or surgery + WBRT versus radiotherapy alone (either WBRT and/or SRS) (OR 1.18 (95% CI: 0.76 – 1.84, p = 0.46). However, surgical patients demonstrated greater risk for local tumor recurrence compared to SRS alone (OR 2.20 (95% CI: 1.49 - 3.25, p < 0.0001)) and compared to WBRT/SRS (OR 2.93; 95% CI: 1.68 - 5.13, p = 0.0002). Conclusion The higher incidence of local tumor recurrence for surgical patients suggests that more prospective studies are needed to clarify outcomes for treatment of 1-4 metastasis less than 4 cm diameter.

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“…5,12,13 Previous work has suggested that patients with single or multiple brain metastases undergoing resection may have improved survival outcomes compared with those undergoing SRS. [14][15][16] However, in recent years there have been advances in SRS technologies, including improved collimation capabilities and image guidance. Indeed, compared with resection, the precision of SRS makes brain metastases in sites of otherwise high surgical morbidity accessible.…”

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confidence: 99%

Stereotactic radiosurgery and resection for treatment of multiple brain metastases: a systematic review and analysis

Mahajan

Shost

Cai

et al. 2022

Neurosurgical Focus

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OBJECTIVE Stereotactic radiosurgery (SRS) has recently emerged as a minimally invasive alternative to resection for treating multiple brain metastases. Given the lack of consensus regarding the application of SRS versus resection for multiple brain metastases, the authors aimed to conduct a systematic literature review of all published work on the topic. METHODS The PubMed, OVID, Cochrane, Web of Science, and Scopus databases were used to identify studies that examined clinical outcomes after resection or SRS was performed in patients with multiple brain metastases. Radiological studies, case series with fewer than 3 patients, pediatric studies, or national database studies were excluded. Data extracted included patient demographics and mean overall survival (OS). Weighted t-tests and ANOVA were performed. RESULTS A total of 1300 abstracts were screened, 450 articles underwent full-text review, and 129 studies met inclusion criteria, encompassing 20,177 patients (18,852 treated with SRS and 1325 who underwent resection). The OS for the SRS group was 10.2 ± 6 months, and for the resection group it was 6.5 ± 3.8 months. A weighted ANOVA test comparing OS with covariates of age, sex, and publication year revealed that the treatment group (p = 0.045), age (p = 0.034), and publication year (0.0078) were all independently associated with OS (with SRS, younger age, and later publication year being associated with longer survival), whereas sex (p = 0.95) was not. CONCLUSIONS For patients with multiple brain metastases, SRS and resection are effective treatments to prolong OS, with published data suggesting that SRS may have a trend toward lengthened survival outcomes. The authors encourage additional work examining outcomes of treatments for multiple brain metastases.

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Comparison of Surgical Resection and Stereotactic Radiosurgery in the Initial Treatment of Brain Metastasis

Cited by 6 publications

References 42 publications

Surgery vs. Radiosurgery for Patients with Localized Metastatic Brain Disease: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Surgery vs. Radiosurgery for Patients with Localized Metastatic Brain Disease: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Management of brain metastasis. Surgical resection versus stereotactic radiotherapy: a meta-analysis

Stereotactic radiosurgery and resection for treatment of multiple brain metastases: a systematic review and analysis

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