Intraoperative radiotherapy for resectable brain metastases: a systematic review and meta-analysis

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-08 DOI:10.1016/j.radonc.2025.111128

Cas Stefaan Dejonckheere , Matthias Schneider , Anna-Laura Potthoff , Motaz Hamed , Davide Scafa , Thomas Zeyen , Lea L. Friker , Molina Grimmer , Fabian Kugel , Stephan Garbe , Alexander Radbruch , Hartmut Vatter , Frank Anton Giordano , Ulrich Herrlinger , Eleni Gkika , Gustavo Renato Sarria , Julian Philipp Layer

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引用次数: 0

Abstract

Background

In recent years, intraoperative radiotherapy (IORT) with low-energy X-rays is emerging as an alternative to postoperative stereotactic radiotherapy (SRT) of the resection cavity in patients with resectable brain metastases (BMs).

Methods

We performed a systematic review of the MEDLINE, Embase, and Scopus databases, including all original articles on IORT for resectable BMs from 2015 to 2025. Data on safety, local control, and survival outcomes were collected.

Results

Ten records (5 prospective single-arm trials) were included, representing 261 patients (49 % lung primary) with a median follow-up (range) of 14 (0–79) months. 77 % of patients had a solitary BM at the time of surgery and IORT. The median applicator size was 2.0 cm and the median prescribed dose (range) 22.3 (20–30) Gy. The 1-year local control rate was 93 % and the 1-year distant brain control rate 48 %. Median overall survival was 19 months. Only 6 % of patients developed leptomeningeal disease and the cumulative rate of radiation necrosis was 2.6 % (grade 1 in 56 % of cases). The median time to next treatment beyond BM therapy (range) was 31 (1–136) days. This was significantly shorter compared to SRT control collectives.

Conclusions

IORT for patients with BMs has a favorable toxicity profile and yields excellent local control. A potential advantage is the rapid completion of interdisciplinary BM treatment, allowing a swift transition to subsequent cancer treatments. A planned registry and a prospective randomized phase 3 trial will establish the preferred radiotherapy modality in the context of resectable BMs.

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术中放疗治疗可切除脑转移瘤：系统回顾和荟萃分析。

背景：近年来，低能x射线术中放疗（IORT）正逐渐成为可切除脑转移瘤（BMs）患者术后立体定向放疗（SRT）的替代方案。方法：我们对MEDLINE、Embase和Scopus数据库进行了系统回顾，包括2015年至2025年关于可切除脑转移的IORT的所有原始文章。收集了安全性、局部控制和生存结果的数据。结果：纳入10项记录（5项前瞻性单臂试验），代表261例患者（49% %肺原发），中位随访（范围）为14（0-79）个月。77% 患者在手术和IORT时有孤立性BM。中位涂药器尺寸为2.0 cm，中位处方剂量（范围）为22.3 (20-30)Gy。1年局部控制率为93 %，1年远端脑控制率为48 %。中位总生存期为19 个月。只有6 %的患者发展为轻脑膜疾病，累积放射性坏死率为2.6 %（56 %的病例为1级）。BM治疗后到下一次治疗的中位时间（范围）为31（1-136）天。与SRT对照组相比，这一时间明显缩短。结论：脑转移患者IORT具有良好的毒性和良好的局部控制效果。一个潜在的优势是跨学科脑转移治疗的快速完成，允许迅速过渡到后续的癌症治疗。计划登记和前瞻性随机3期试验将确定可切除脑转移的首选放疗方式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.