Cancer Treatment Reviews
Volume 32, Issue 3 , Pages 203-213, May 2006

Effectiveness of stereotactic radiosurgery alone or in combination with whole brain radiotherapy compared to conventional surgery and/or whole brain radiotherapy for the treatment of one or more brain metastases: A systematic review and meta-analysis

  • Tania Stafinski

      Affiliations

    • Institute of Health Economics, 1200, 10405 Jasper Avenue, Edmonton, Alta., Canada T5J 3N4
    • Tel.: +1 780 448 4881; fax: +1 780 448 0018.
    • ,
  • Gian S. Jhangri

      Affiliations

    • Department of Public Health Sciences, University of Alberta, 13-106G Clinical Sciences Building, University of Alberta, Edmonton, Alta., Canada T6G 2G3
    • Tel.: +1 780 492 6816; fax: +1 780 492 0364.
    • ,
  • Elizabeth Yan

      Affiliations

    • Division of Radiation Oncology, Tom Baker Cancer Centre, 1331-29th Street, NW, Calgary, Alta., Canada T2N 4N2
    • Tel.: +1 403 521 3164; fax: +1 403 283 1651.
    • ,
  • Devidas Menon

      Affiliations

    • Health Policy and Management Professional Program, Department of Public Health Sciences, University of Alberta, 13-103 Clinical Sciences Building, Edmonton, Alta., Canada T6G 2G3
    • Corresponding Author InformationCorresponding author. Tel.: +1 780 492 9080; fax: +1 780 492 9070.

Received 30 October 2005; accepted 20 December 2005. published online 14 February 2006.

Summary 

Purpose

To assess the effectiveness of SRS alone or in combination with WBRT compared to surgery and/or WBRT in prolonging survival and improving the quality-of-life and functional status of patients with brain metastases.

Methods and materials

A meta-analysis of randomized controlled trials and concurrent cohort studies examining SRS versus SRS+WBRT, SRS versus WBRT +/− surgical resection, SRS versus surgical resection only, or SRS+WBRT versus WBRT was conducted. Trial registers, bibliographic databases, and reference lists from selected studies and recent issues of relevant journals were searched. Neuro-oncology specialists were also contacted. All studies were analyzed independently by two reviewers, applying validated critical appraisal techniques.

Results

The review identified three RCTs and one cohort study. Among patients with multiple metastases, no difference in survival between those treated with WBRT+SRS and those treated with WBRT was found. However, in patients with one metastasis, a statistically significant difference, favoring those treated with WBRT+SRS, was observed. Regarding local tumor control at 24 months, rates were significantly higher in the WBRT+SRS treatment arm, regardless of the number of metastases.

Conclusions

Adding SRS to WBRT improves survival in patients with one brain metastasis. Combining SRS and WBRT improves local tumour control and functional independence in all patients.

Keywords: Brain metastases, Stereotactic radiosurgery, Meta-analysis, Systematic review

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PII: S0305-7372(06)00006-5

doi:10.1016/j.ctrv.2005.12.009

Cancer Treatment Reviews
Volume 32, Issue 3 , Pages 203-213, May 2006

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