Stereotactic Radiosurgery Versus Stereotactic Radiotherapy in the Management of Intracranial Meningiomas: A Systematic Review and Meta-Analysis

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Abstract INTRODUCTION The aim of this analysis is to compare the safety and long-term efficacy of stereotactic radiosurgery (SRS) and SRT in patients with primary or recurrent ICMs. METHODS A systematic review was carried out using different MeSH terms from the electronic database. Randomized controlled trials, case-control studies, and cohort studies (prospective and retrospective) analyzing SRS vs SRT for the treatment of ICMs in adult patients (age > 16 yr old) were included. RESULTS A total of 1736 patients from 12 retrospective studies were included. The treatment modality was SRS (n = 306) including Gamma Knife (GKS) (n = 36), LINAC (n = 261), and CyberKnife (n = 9), or SRT (n = 1430) including hypofractionated radiation therapy (hFSRT) (n = 268) and full-fractionated radiation therapy (FSRT) (n = 1162). The median age of patients at the time of treatment was 59 yr. The median follow-up after treatment was 35.5 mo. The median tumor volume at the time of treatment with SRS, hFSRT, and FSRT was, respectively, 2.84 cm3, 5.45 cm3, and 12.75 cm3. The radiographic tumor control at last follow-up was significantly worse in patients who underwent SRS than SRT [OR: 0.47: 95% CI 0.27-0.82, P = .007] with 7% less volume of tumor shrinkage [OR: 0.93; 95% CI: 0.61-1.40; P = .72]. Compared to SRS, the radiographic tumor control was better achieved by FSRT [OR: 0.46: 95% CI 0.26-0.80, P = .006] than by hFSRT [OR: 0.81: 95% CI 0.21-3.17; P = .76]. Moreover, SRS leads to a significantly higher risk of clinical neurological worsening during follow-up [OR: 2.07: 95% CI: 1.06-4.06; P = .03], and of immediate symptomatic edema [OR: 4.58: 95% CI: 1.67-12.56; P = .003] with respect to SRT. SRT could carry a better progression-free survival (PFS) at 4 to 10 yr compared to SRS, yet not statistically significant (P = .29). CONCLUSION SRS and SRT are both safe options in the management of ICMs However, SRT carries a better radiographic tumor control rate, lower incidence of post-treatment symptomatic worsening and symptomatic edema, with respect to SRS.