Cyberknife® Radiosurgery and Fractionated Stereotactic Radiotherapy For Brainstem or Adjacent-to-Brainstem Metastases

Efficacy and Safety of Stereotactic Radiosurgery for Brainstem Metastases

“…The 1-year OS was 33% (95% CI, 30%-37%; I 2 = 35%; P = .04; Figure 1D) in 1254 patients across 27 studies, and the 2-year OS was 13% (95% CI, 11%-16%; I 2 = 30%; P = .10; eFigure 8 in Supplement 2) in 959 patients across 22 studies. Death attributed to BSM progression was rare (19 of 703 [2.7%] deaths across 19 studies).…”

“…The 1-year LC was 86% (95% CI, 83%-88%; I 2 = 38%; P = .12 for heterogeneity; Figure 1A) in 1410 patients across 31 studies, the ORR was 59% (95% CI, 47%-71%; I 2 = 88%; P < .001; Figure 1B) in 642 patients across 17 studies (eFigure 3A in Supplement 2), and the rate of symptom improvement was 55% (95% CI, 47%-63%; I 2 = 41%; P = .06; Figure 1C) in 323 patients across 13 studies. Prior or concurrent WBRT (coefficient, −1.90; Q M = 5.26; P = .02), or symptomatic BSM (coefficient, −2.43; Q M = 5.11; P = .02) were associated with decreased ORR.…”

“…A total of 78 (5.6%) patients experienced symptomatic toxic effects of any grade after SRS for BSM, and the rate of grade 3 to 5 toxic effects was 2.4% (95% CI, 1.5%-3.7%; I 2 = 33%; P = .97; Figure 2B) in 1421 patients across 31 studies. The rate of adverse radiation effect/radionecrosis was 1.5% (21 of 1386 patients across 31 studies), and the rate of symptomatic radiation effect was 1.1% (15 of 1361 patients across 30 studies).…”

“…Nearly all prospective trials of SRS for BM have excluded patients with BSM . Thus, reports of SRS for BSM are limited to small retrospective series, and the efficacy and safety of SRS for BSM are incompletely understood. To address this unmet need, we performed a quantitative meta-analysis of SRS for BSM to estimate pooled measures of efficacy and safety in the context of prospective trials of SRS or molecular therapy for nonbrainstem BM.…”