Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Mar 9;4(1):vdac033.
doi: 10.1093/noajnl/vdac033. eCollection 2022 Jan-Dec.

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

David T Krist  1   2 , Anant Naik  1   2 , Charee M Thompson  1   2   3 , Susanna S Kwok  1   2 , Mika Janbahan  1   2 , William C Olivero  1   2 , Wael Hassaneen  1   2
Affiliations
Review

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

David T Krist et al. Neurooncol Adv. .

Abstract

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 = .23) or surgery + WBRT versus radiotherapy alone (either WBRT and/or SRS) (OR 1.18 (95% CI: 0.76-1.84, P = .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 < .0001)) and compared to WBRT/SRS (OR 2.93; 95% CI: 1.68-5.13, P = .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.

Keywords: brain metastasis; local tumor control; meta-analysis; stereotactic radiotherapy; surgical resection.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA flow diagram illustrating how records were identified and selected.
Figure 2.
Figure 2.
Forest plots of odds ratios from studies comparing the survival outcomes of patients undergoing initial surgical resection followed by SRS versus SRS alone in the treatment of a brain metastases (A.) one year after treatment, and (B.) two years after treatment. The contributing studies are summarized in Table 1. Abbreviations: OR, odds ratio; CI, confidence interval.
Figure 3.
Figure 3.
Forest plots of odds ratios from studies comparing the local tumor recurrence outcomes of patients undergoing initial surgical resection followed by SRS versus SRS alone in the treatment of brain metastases (A.) one year after treatment and, (B.) two years after treatment. The contributing studies are summarized in Table 1. Abbreviations: OR, odds ratio; CI, confidence interval; SRS, stereotactic radiosurgery.
Figure 4.
Figure 4.
Forest plots of odds ratios from studies comparing the local tumor recurrence outcomes of patients undergoing initial surgical resection followed by radiation versus radiation alone in the treatment of brain metastases. (A.) one year after treatment and, (B.) at the end of study timepoint (Overall). The contributing studies are summarized in Table 2 and predominantly utilize whole-brain radiotherapy. Abbreviations: OR, odds ratio; CI, confidence interval; SRS, stereotactic radiosurgery.
See this image and copyright information in PMC

References

    1. Lamba N, Wen PY, Aizer AA. Epidemiology of brain metastases and leptomeningeal disease. Neuro Oncol. 2021;23(9):1447–1456. - PMC - PubMed
    1. Achrol AS, Rennert RC, Anders C, et al. . Brain metastases. Nat Rev Dis Primers. 2019;5(1):1–26. - PubMed
    1. Kalkanis SN, Kondziolka D, Gaspar LE, et al. . The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96(1):33–43. - PMC - PubMed
    1. Suki D, Aziz Hatiboglu M, Sawaya R. Evolution of neurosurgical treatment for brain metastases over a 20-Year period: experience at a large referral cancer center. Neurosurg. 2020;67(Supplement_1):19–28.
    1. Patchell RA, Tibbs PA, Walsh JW, et al. . A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500. - PubMed

LinkOut - more resources