Stereotactic radiosurgery for treatment of patients with brain metastases iQWiG reports - commission no. N20-04
Beyond the results reported in the studies, single-session SRS has treatment-inherent advantages over WBRT in terms of repeatable application of the intervention and in terms of treatment-related burden. Thus, a hint of a greater benefit of SRS can be also be derived for the comparison of single-ses...
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| Format: | eBook |
| Language: | English |
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Köln, Germany
Institute for Quality and Efficiency in Health Care (IQWiG)
14 January 2022, 2022
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| Edition: | Version 1.0 |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Beyond the results reported in the studies, single-session SRS has treatment-inherent advantages over WBRT in terms of repeatable application of the intervention and in terms of treatment-related burden. Thus, a hint of a greater benefit of SRS can be also be derived for the comparison of single-session SRS versus WBRT in the overall assessment across outcomes RESEARCH QUESTION: The aim of the present investigation is to assess the benefit of treatment with single-session stereotactic radiosurgery (SRS) with linear accelerators or cobalt-60-gamma radiation sources (also in combination with surgical resection) versus treatment with microsurgical resection (also in combination with whole brain radiation therapy, WBRT) or WBRT in each case in patients with one or a few brain metastases requiring treatment. The focus of the assessment was on patient-relevant outcomes. CONCLUSION: A total of 7 randomized controlled trials (RCTs) were included in the present assessment. These were assigned to 2 different comparisons, depending on the control intervention investigated. For the comparison of single-session SRS versus microsurgical resection (Comparison 1), a treatment-inherent advantage of SRS with regard to length of hospital stay was found. However, due to the risk of publication bias of a relevant magnitude, no conclusion regarding a greater benefit or harm of either treatment option could be drawn for this comparison across outcomes. Nor could valid conclusions be drawn regarding a comparable benefit of SRS. Due to the intervention-specific differences in invasiveness and length of hospital stay, the present results suggest that single-session SRS in patients with one or a few brain metastases may have the potential to be a necessary treatment alternative to resection. The prospects of success of a testing study for this comparison must be considered very low due to the known recruitment problems. For the comparison of single-session SRS versus WBRT (Comparison 2), data from a total of 6 randomized trials could be used, of which 1 had a high and 5 had a moderate qualitative certainty of results across outcomes. In terms of all-cause mortality, across studies, overall the data provide no hint of a greater benefit or harm of any of the treatment options. In addition, the available results do not suggest with sufficient certainty that SRS provides at least comparable overall survival versus WBRT. With regard to memory performance as a subcomponent of cognitive function, there was a hint of a greater benefit of SRS, but not for other components of cognitive function, such as speech fluency or executive functions. For the outcomes of activities of daily living, adverse events and treatment-related complications, and health-related quality of life, there was no hint of a greater benefit or harm of any of the treatment options. For the outcome of neurological function, no usable data were identified. |
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| Item Description: | Translation of Chapters 1 to 6 of the final report N20-04 Stereotaktische Radiochirurgie zur Behandlung von Patientinnen und Patienten mit Hirnmetastasen (Version 1.0; Status: 14 January 2022 [German original],12 August 2022 [English translation]) |
| Physical Description: | 1 PDF file (vi, 37 pages) illustrations |