MMDA-11 COMPARATIVE OUTCOMES OF STEREOTACTIC RADIOSURGERY ALONE VERSUS SURGICAL RESECTION PLUS RADIOSURGERY FOR LARGE BRAIN METASTASES: A SYSTEMATIC REVIEW AND META-ANALYSIS
Ruchit Jain, Khalid Ahmad Qidwai, Zouina Sarfraz, Namita Ruhela, Fatma Nihan Akkoc Mustafayev, Manmeet Singh AhluwaliaAbstract
Background
Optimal management of large brain metastases (BM) remains controversial. While surgery followed by stereotactic radiosurgery (SRS) is commonly used for accessible lesions, SRS alone is increasingly utilized, particularly in patients who are not surgical candidates. We performed a meta-analysis to compare survival and local control outcomes between these approaches.
Methods
A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted to identify comparative studies evaluating SRS alone versus surgery followed by SRS for large BM. The primary outcomes were 1-year overall survival (OS) and local control. Risk ratios (RRs) were pooled using a random-effects model.
Results
Five studies comprising 828 patients (SRS: 423; surgery + SRS: 405) were included. Median age was similar between groups (SRS: 61 years [range, 59.2–62]; surgery: 61 years [range, 58–66]). Median tumor volume in the SRS cohort was 5.9 cc (range, 5.4–6.6) and 15.0 cc (range, 9.6–15.2) in the surgery cohort. Median follow-up was shorter in the SRS group (13 months [range, 8.5–22]) than in the surgery group (22 months [range, 13–23]). Surgery followed by SRS was associated with improved OS (pooled HR 0.48, 95% CI 0.32-0.7, p = 0.0143). Consistent with this, surgery followed by SRS was also associated with a lower risk of 1-year mortality (RR 0.65, 95% CI 0.54–0.78, p < 0.001; I² = 0%) and a lower risk of 1-year local failure (RR 0.62, 95% CI 0.46–0.84, p = 0.002; I² = 0%).
Conclusions
Resection followed by SRS was associated with improved survival and local control compared with SRS alone for large brain metastases. Prospective comparative studies are needed to define optimal patient selection and treatment strategies.