Evaluation of Adjuvant Whole Brain Radiotherapy After Stereotactic Radiosurgery of Brain Metastases

Abstract

Stereotactic radiosurgery is frequently used either alone or together with whole brain radiotherapy to treat brain metastases. Some studies reported better results with combination of WBRT+SRS, while others reported that WBRT didn’t enhance the effect of SRS. The aim of this meta-analysis is to determine whether WBRT+SRS or SRS alone will result in better clinical outcomes for patients with brain metastases . The meta-analyses were done using an online effect size calculator -based on the reference(practical meta-analysis) by David.B Wilson- on the following outcomes : survival rate, local tumor recurrence rate, new distant brain metastases recurrence rate, and the neuorologic radiation toxicity rate . It is found that : the local tumor recurrence and the new distant brain metastases recurrence rates had been reduced in the WBRT+SRS group with Odds Ratios of 0.36 and 0.44 respectively; but the neuorologic radiation toxicity rate was higer in the WBRT+SRS group with an Odds Ratio of 3.84 . And there was no significant difference in one year survival rate between the two groups with an Odds Ratio of 0.54 . It is concluded that: the WBRT reduces the local tumor recurrence and new brain metastases recurrence; but worsens the neuorocognitive function in the patients. On other hand, the addition of WBRT to SRS didn’t improve the survival for patients with brain metastases. vi