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Meta-Analysis
. 2025 Feb 10;27(2):517-532.
doi: 10.1093/neuonc/noae204.

Pediatric cranial stereotactic radiosurgery: Meta-analysis and international stereotactic radiosurgery society practice guidelines

Erin S Murphy  1 , Arjun Sahgal  2 , Jean Regis  3 , Marc Levivier  4 , Laura Fariselli  5 , Alessandra Gorgulho  6   7 , Lijun Ma  8 , Bruce Pollock  9 , Shoji Yomo  10 , Jason Sheehan  11 , Ian Paddick  12 , John H Suh  1 , Anshul Saxena  13 , Md Ashfaq Ahmed  13 , Rupesh Kotecha  14
Affiliations
Meta-Analysis

Pediatric cranial stereotactic radiosurgery: Meta-analysis and international stereotactic radiosurgery society practice guidelines

Erin S Murphy et al. Neuro Oncol. .

Abstract

Background: There are limited data on the use of stereotactic radiosurgery (SRS) for pediatric patients. The aim of this systematic review was to summarize indications and outcomes specific to pediatric cranial SRS to inform consensus guidelines on behalf of the International Stereotactic Radiosurgery Society.

Methods: A systematic review, using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, analyzed English-language articles on SRS, published between 1989 and 2021, that included outcomes for at least 5 pediatric patients. MEDLINE database terms included tumor types and locations, and radiosurgical and age-specific terms. We excluded nonclinical reports, expert opinions, commentaries, and review articles. Meta-regressions for associations with local control were performed for medulloblastoma, craniopharyngioma, ependymoma, glioma, and arteriovenous malformation (AVM).

Results: Of the 113 articles identified for review, 68 met the inclusion criteria. These articles described approximately 400 pediatric patients with benign and malignant brain tumors and 5119 with AVMs who underwent cranial SRS. The rates of local control for benign tumors, malignant tumors, and AVMs were 89% (95% CI, 82%-95%), 71% (95% CI, 59%-82%), and 65% (95% CI, 60%-69%), respectively. No significant associations were identified for local control with the patient-, tumor-, or treatment-related variables.

Conclusions: This review is the first to summarize outcomes specific to SRS for pediatric brain tumors and AVMs. Although data reporting is limited for pediatric patients, SRS appears to provide acceptable rates of local control. We present ISRS consensus guidelines to inform the judicious use of cranial SRS for pediatric patients.

Keywords: arteriovenous malformations; brain neoplasms; pediatric; stereotactic radiosurgery.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Forest plot showing the proportion of patients achieving local control (with 95% confidence intervals) using pediatric cranial stereotactic radiosurgery for medulloblastoma, craniopharyngioma, ependymoma, glioma, and arteriovenous malformation. Abbreviations: AMV, arteriovenous malformation; ES, effect size.
See this image and copyright information in PMC

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