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Frameless Stereotactic Radiosurgery for Brain Metastasis: A Systematic Review and Meta-Analysis Publisher Pubmed



Habibi MA1 ; Mirjnani MS2 ; Ghazizadeh Y3 ; Norouzi A2 ; Minaee P2 ; Eazi S2 ; Atarod MH2 ; Aliasgary A2 ; Noroozi MZ4 ; Hajikarimloo B5 ; Sheehan JP6
Authors
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Authors Affiliations
  1. 1. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Student Research Committee, Qom University of Medical Sciences, Qom, Iran
  3. 3. Student Research Committee, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Student Research Committee of Shahid Beheshti, University of Medical Sciences, Tehran, Iran
  5. 5. Department of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  6. 6. Department of Neurological Surgery, University of Virginia, Charlottesville, United States

Source: Neurosurgical Review Published:2024


Abstract

Stereotactic Radiosurgery (SRS) delivers a high dose of radiation to a specific brain area while limiting radiation to nearby healthy tissue. While most SRS has traditionally been performed with a stereotactic frame-based approach, this study aims to investigate the safety and efficacy of frameless radiosurgery in patients with brain metastases. Our study followed the recommended guidelines summarized in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The electronic databases of PubMed/Medline, Scopus, Embase, and Web of Science (WOS) were searched from inception to 10 October 2023. The pooled rate of outcomes was calculated using random effect model and Restricted maximum–likelihood (REML) method. All statistical analysis was performed by STATA V.17. A total of 499 studies were recruited from the electronic databases. After removing duplicates (n = 117), 382 studies were used for title/abstract, and 329 were removed from the study selection process. A total of 53 articles were used for full-text assessment, and 35 studies were included for data extraction. Our analysis revealed a significant increase across all pooled survival rates and local control rates by initiating the radiosurgery for patients, estimating the pooled 6-month OSR of 75% (95% CI: 68-81%), 1-year overall survival rate (OSR) of 60% (95% CI: 51-69%), 18-month OSR of 48% (95% CI: 10-85%), 2-year OSR of 39% (95% CI: 19-58%), 1-year progression-free survival rate (PFSR) of 68% (95% CI: 39-98%), 2-year PFSR of 75% (95% CI: 58-91%), 6-month local control rate (LCR) of 93% (95% CI: 90-96%), and 12-month LCR of 86% (95% CI: 82-90%). Our meta-analysis findings confirm the efficacy of frameless radiosurgery in treating brain metastases. Using data from several trials, we were able to demonstrate stereotactic radiosurgery’s effectiveness as a therapy option for brain metastasis patients, demonstrating local control and reasonable overall survival. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
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