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Stereotactic radiosurgery: a meta-analysis of current therapeutic applications in neuro-oncologic disease

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Abstract

Stereotactic radiosurgery (SRS) represents an important tool in neurosurgery and radiotherapy for addressing a multitude of diseases, most notably in the field of neuro-oncology. The pathologies for which it is employed vary significantly, and few controlled studies exist to evaluate its efficacy. We aimed to provide a quantitative meta-analysis of SRS applications in neuro-oncology, providing benchmarks for expected outcomes. The meta-analysis was conducted in accordance with established standards for evaluating observational data. Specific inclusion criteria were utilized, search terms recorded, and data extracted to summarize demographic and outcome statistics. Meta-analysis was conducted where statistically appropriate, and clinical outcomes summarized as tumor stability, survival, and complications in a pathology-specific manner. For vestibular schwannoma, 37 studies with a total 3,677 patients were included. Overall disease stabilization rate after adjustment for significant publication bias was 91.1%. Non-cranial nerve complication rate after publication bias adjustment was 5.6%. Accounting for publication bias, rate of hearing preservation was with 59.3%. For 456 glioblastoma multiforme (GBM) patients in 11 studies receiving SRS, median survival from diagnosis was 13.5–26 months, while overall complication rate was 11.4%. For meningioma, 15 studies with a total 2,734 patients were included; 77.1% were classified as skull base. Overall disease stabilization rate was 89.0, while overall complication rate was 7.0%. For metastatic disease, 27 studies with a total of 2,679 patients were included. Overall median survival from time of SRS was 5–14 months, overall 1-year survival rates were 15–54.9%, while reported local disease control rates were 59.6–96.8%. Stereotactic radiosurgery is an increasingly important tool in the management of neuro-oncologic diseases. While there is a pathology-specific role for SRS, current data show excellent results in treating several pathologies. As such, SRS adds significantly to the neurosurgical armamentarium for treating neuro-oncologic processes.

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Acknowledgments

We appreciate the contribution of Suzanne Ross, who provided editorial assistance. We appreciate the assistance of Linda M. Gerber, PhD and Ya-Lin Chiu, MS from the Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College for their consultation regarding the statistical analysis. The authors report no conflicts of interests or sources of funding in reference to this manuscript. All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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  1. Department of Neurological Surgery, Weill Cornell Medical College—New York Presbyterian Hospital, 525 E. 68th Street, P.O. Box 99, New York, NY, 10065, USA

    Susan C. Pannullo, Justin F. Fraser, Jennifer Moliterno, William Cobb & Philip E. Stieg

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  1. Susan C. Pannullo
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  2. Justin F. Fraser
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  3. Jennifer Moliterno
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  5. Philip E. Stieg
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Correspondence to Philip E. Stieg.

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Pannullo, S.C., Fraser, J.F., Moliterno, J. et al. Stereotactic radiosurgery: a meta-analysis of current therapeutic applications in neuro-oncologic disease. J Neurooncol 103, 1–17 (2011). https://doi.org/10.1007/s11060-010-0360-0

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