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
. 2023 Jul 26;15(15):3802.
doi: 10.3390/cancers15153802.

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

Giorgio Fiore  1   2   3 , Leonardo Tariciotti  1   2 , Giulio Andrea Bertani  1 , Dario Gagliano  1   2 , Antonio D'Ammando  1 , Antonella Maria Ampollini  1 , Luigi Schisano  1 , Stefano Borsa  1 , Mauro Pluderi  1 , Marco Locatelli  1   2 , Manuela Caroli  1
Affiliations
Review

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

Giorgio Fiore et al. Cancers (Basel). .

Abstract

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.

Keywords: brain metastasis; oligometastasis; progression-free survival; radiosurgery; radiotherapy; solitary brain metastasis; surgery; surgical resection; survival; whole brain radiotherapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram according to the PRISMA guidelines.
Figure 2
Figure 2
Risk of Bias [28,29,30].
Figure 3
Figure 3
Forest plot of OS comparison between radiosurgery and surgery [28,29,30].
Figure 4
Figure 4
Forest plot of death rate comparison between radiosurgery and surgery at 1 (A) and 2 (B) years [28,29,30].
Figure 5
Figure 5
Forest plot of PFS comparison between radiosurgery and surgery [28,30].
Figure 6
Figure 6
Forest plot of recurrence rate comparison between radiosurgery and surgery at 1 (A) and 2 (B) years [28,30].
Figure 7
Figure 7
Forest plot of PFS comparison between radiosurgery alone and surgical resection + WBRT [28,30].
Figure 8
Figure 8
Forest plots of OS (A) and death rate comparison at 1 (B) and 2 (C) years between radiosurgery and surgery [29,30].
See this image and copyright information in PMC

References

    1. Nayak L., Lee E.Q., Wen P.Y. Epidemiology of Brain Metastases. Curr. Oncol. Rep. 2012;14:48–54. doi: 10.1007/s11912-011-0203-y. - DOI - PubMed
    1. Fuentes R., Cosp X.B., Hernandez J.E. Surgery versus Radiosurgery for Patients with a Solitary Brain Metastasis from Non-Small Cell Lung Cancer. Cochrane Database Syst. Rev. 2006 doi: 10.1002/14651858.CD004840.pub2. - DOI - PMC - PubMed
    1. Sperduto P.W., Mesko S., Li J., Cagney D., Aizer A., Lin N.U., Nesbit E., Kruser T.J., Chan J., Braunstein S., et al. Survival in Patients with Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. J. Clin. Oncol. 2020;38:3773–3784. doi: 10.1200/JCO.20.01255. - DOI - PMC - PubMed
    1. Lang F.F., Sawaya R. Surgical Treatment of Metastatic Brain Tumors. Semin. Surg. Oncol. 1998;14:53–63. doi: 10.1002/(SICI)1098-2388(199801/02)14:1<53::AID-SSU7>3.0.CO;2-1. - DOI - PubMed
    1. Roos D. What Is the Randomised Evidence for Surgery and Stereotactic Radiosurgery for Patients with Solitary (or Few) Brain Metastases? Int. J. Evid. Based Healthc. 2011;9:61–66. doi: 10.1111/j.1744-1609.2010.00201.x. - DOI - PubMed

LinkOut - more resources