MMDA-11 COMPARATIVE OUTCOMES OF STEREOTACTIC RADIOSURGERY ALONE VERSUS SURGICAL RESECTION PLUS RADIOSURGERY FOR LARGE BRAIN METASTASES: A SYSTEMATIC REVIEW AND META-ANALYSIS

作者：Ruchit Jain, Khalid Qidwai, Zouina Sarfraz, Namita Ruhela, Fatma Nihan Akkoc Mustafayev, Manmeet Singh Ahluwalia · 发表于：Neuro-Oncology Advances · 年份：2026 · DOI：10.1093/noajnl/vdag161.039 · 研究领域：Brain Metastases and Treatment、Advanced Radiotherapy Techniques、Meningioma and schwannoma management

Abstract 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...