Radiotherapeutic management of metastatic brain disease: a two-decade meta-analysis of tumor control and neurocognitive outcomes with SRS alone versus SRS plus WBRT - PubMed
4 hours ago
- #Neurocognitive Outcomes
- #Stereotactic Radiosurgery
- #Brain Metastases
- Brain metastases are common intracranial tumors in adults, with stereotactic radiosurgery (SRS) being widely used for management.
- This meta-analysis compares SRS alone versus SRS combined with whole-brain radiotherapy (WBRT) in 1,757 patients from 6 cohort studies and 4 randomized controlled trials.
- Overall survival (OS) was comparable between both treatment groups (HR = 1.06; p = 0.60).
- Local tumor control (LTC) rates were 77.71% for SRS alone and 87.25% for SRS+WBRT, with no significant difference (p = 0.07).
- Recurrence rate was significantly lower with SRS+WBRT (13.9%) compared to SRS alone (37%) (RR = 0.37; p = 0.0005).
- Radionecrosis (RN) rates were comparable, with 3.7% for SRS+WBRT and 3.5% for SRS alone (p = 0.98).
- Neurocognitive deterioration (NCD) ≥1SD from baseline was more frequent in the SRS+WBRT group (RR = 0.64; p = 0.005).
- Conclusion: SRS is effective and safe; combining with WBRT improves recurrence rates but increases NCD without clear OS benefit, highlighting need for individualized treatment.