Raj Singh, John G Roubil, Eric J Lehrer, Gael Muanamputu, Evan M Thomas, Sasha J Beyer, Raju R Raval, Rupesh Kotecha, Joshua D Palmer
{"title":"The Impact of Margin Expansions on Local Control and Radionecrosis Following Stereotactic Radiosurgery for Brain Metastases: A Systematic Review and Meta-Analysis.","authors":"Raj Singh, John G Roubil, Eric J Lehrer, Gael Muanamputu, Evan M Thomas, Sasha J Beyer, Raju R Raval, Rupesh Kotecha, Joshua D Palmer","doi":"10.1016/j.prro.2025.01.012","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The implications of margin expansions on local control(LC) and radionecrosis(RN) for treating brain metastases with stereotactic radiosurgery(SRS) remain unclear. We performed a systematic review and meta-analysis to compare LC and RN between patients with brain metastases treated with stereotactic radiosurgery(SRS) planned with no margin vs. a margin.</p><p><strong>Methodology: </strong>We utilized PICOS/PRISMA/MOOSE selection inclusion criteria for studies of patients with brain metastases treated with SRS with no margin or a margin. Primary outcomes were 1-year LC and radiographic and symptomatic RN incidences. Weighted random effects meta-analyses were performed to compare effect sizes.</p><p><strong>Results: </strong>Across 17 studies, we identified 5,015 lesions treated with SRS (1,360 lesions with no margin and 3,684 with a margin). The median total margin was 1.5 mm (range: 1-3). Single fraction SRS was most common with a median prescription dose of 21 Gy (range: 15-24 Gy). The estimated 1-year LC rate was similar with a margin (88.4% (95% CI: 83.7-92.4%) vs. without (83.0% (95% CI: 69.3-93.2%; p = 0.28)). Estimated incidences of radiographic RN following SRS with no margin vs. a margin were similar at 9.2% (95% CI: 0.2-29.6%) and 7.0% (95% CI: 4.1-10.7%; p=0.56), respectively. Estimated incidences of symptomatic RN following SRS with no margin vs. with a margin were 8.6% (95% CI: 5.2-12.7%) and 4.1% (95% CI: 0.9-9.3%), respectively (p=0.24).</p><p><strong>Conclusions: </strong>Significant differences were not noted in either LC or RN for patients treated with margin expansions vs. without. Prospective evaluations are warranted to further assess this question while controlling for other relevant treatment planning and metastasis considerations.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Practical Radiation Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.prro.2025.01.012","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
The Impact of Margin Expansions on Local Control and Radionecrosis Following Stereotactic Radiosurgery for Brain Metastases: A Systematic Review and Meta-Analysis.
Purpose: The implications of margin expansions on local control(LC) and radionecrosis(RN) for treating brain metastases with stereotactic radiosurgery(SRS) remain unclear. We performed a systematic review and meta-analysis to compare LC and RN between patients with brain metastases treated with stereotactic radiosurgery(SRS) planned with no margin vs. a margin.
Methodology: We utilized PICOS/PRISMA/MOOSE selection inclusion criteria for studies of patients with brain metastases treated with SRS with no margin or a margin. Primary outcomes were 1-year LC and radiographic and symptomatic RN incidences. Weighted random effects meta-analyses were performed to compare effect sizes.
Results: Across 17 studies, we identified 5,015 lesions treated with SRS (1,360 lesions with no margin and 3,684 with a margin). The median total margin was 1.5 mm (range: 1-3). Single fraction SRS was most common with a median prescription dose of 21 Gy (range: 15-24 Gy). The estimated 1-year LC rate was similar with a margin (88.4% (95% CI: 83.7-92.4%) vs. without (83.0% (95% CI: 69.3-93.2%; p = 0.28)). Estimated incidences of radiographic RN following SRS with no margin vs. a margin were similar at 9.2% (95% CI: 0.2-29.6%) and 7.0% (95% CI: 4.1-10.7%; p=0.56), respectively. Estimated incidences of symptomatic RN following SRS with no margin vs. with a margin were 8.6% (95% CI: 5.2-12.7%) and 4.1% (95% CI: 0.9-9.3%), respectively (p=0.24).
Conclusions: Significant differences were not noted in either LC or RN for patients treated with margin expansions vs. without. Prospective evaluations are warranted to further assess this question while controlling for other relevant treatment planning and metastasis considerations.
期刊介绍：
The overarching mission of Practical Radiation Oncology is to improve the quality of radiation oncology practice. PRO''s purpose is to document the state of current practice, providing background for those in training and continuing education for practitioners, through discussion and illustration of new techniques, evaluation of current practices, and publication of case reports. PRO strives to provide its readers content that emphasizes knowledge "with a purpose." The content of PRO includes:
Original articles focusing on patient safety, quality measurement, or quality improvement initiatives
Original articles focusing on imaging, contouring, target delineation, simulation, treatment planning, immobilization, organ motion, and other practical issues
ASTRO guidelines, position papers, and consensus statements
Essays that highlight enriching personal experiences in caring for cancer patients and their families.
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