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Efficacy of neoadjuvant stereotactic radiotherapy in brain metastases from solid cancer: a systematic review of literature and meta-analysis

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Abstract

Neoadjuvant stereotactic radiotherapy (NaSRT) is a novel strategy for brain metastasis (BM) treatment, promising to achieve good local control, improved survival, and low toxicity. This is a systematic review of available literature and meta-analysis of 8 articles eligible for inclusion after searching MEDLINE via PubMed, Web-of-science, Cochrane Wiley, and Embase databases up to March 2023. A total of 484 patients undergoing NaSRT to treat 507 lesions were included. The median age was 60.9 (IQR 57–63) years, with a median tumor volume of 12.1 (IQR 9–14) cm3. The most frequent histology was non-small-cell lung cancer (41.3%), followed by breast (18.8%), and melanoma (14.3%). Lesions had a preferred supratentorial location (77.4%). Most of the studies used a single fraction schedule (91% of patients, n = 440). Treatment parameters were homogeneous and showed a median dose of 18 (IQR 15.5–20.5) Gy at a median of 80% isodose. Surgery was performed after a median of 1.5 (IQR 1–2.4) days and achieved gross-total extent in 94% of cases. Median follow-up was 12.9 (IQR 10–15.7) months. NaSRT showed an overall mortality rate of 58% (95% CI 43–73) at the last follow-up. Actuarial outcomes rates were 60% (95% CI 55–64) for 1-year overall survival (1y-OS), 38% (95% CI 33–43) for 2y-OS, 29% (95% CI 24–34) for 3y-OS; overall 15% (95% CI 11–19) for local failure, 46% (95% CI 37–55) for distant brain failure, 6% (95% CI 3–8) for radionecrosis, and 5% (95% CI 3–8) for leptomeningeal dissemination. The median local progression-free survival time was 10.4 (IQR 9.5–11.4) months, while the median survival without distant failure was 7.4 (IQR 6.9–8) months. The median OS time for the entire cohort was 17 (IQR 14.9–17.9) months. Existing data suggest that NaSRT is effective and safe in the treatment of BMs, achieving good local control on BMs with and low incidence of radionecrosis and leptomeningeal dissemination. Distant control appears limited compared to other radiation regimens.

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Authors and Affiliations

  1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy

    Filippo Gagliardi, Pierfrancesco De Domenico, Silvia Snider, Maria Grazia Nizzola & Pietro Mortini

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  1. Filippo Gagliardi
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  2. Pierfrancesco De Domenico
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  3. Silvia Snider
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  4. Maria Grazia Nizzola
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  5. Pietro Mortini
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Filippo Gagliardi, Pierfrancesco De Domenico, Silvia Snider, Mariagrazia Nizzola, and Pietro Mortini. The first draft of the manuscript was written by Filippo Gagliardi and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Filippo Gagliardi.

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Gagliardi, F., De Domenico, P., Snider, S. et al. Efficacy of neoadjuvant stereotactic radiotherapy in brain metastases from solid cancer: a systematic review of literature and meta-analysis. Neurosurg Rev 46, 130 (2023). https://doi.org/10.1007/s10143-023-02031-2

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