A Systematic Review of Multimodal Treatment for 1 to 4 Brain Metastases

Abstract

Treatment of brain metastases are controversial, being the optimal therapeutic combination still unknown. The aim of the present work was to determine the outcome differences among Whole Brain Radiation Therapy, Stereotactic Radiosurgery and Surgical Resection in terms of Overall Survival, Functional Independence, Local Control, Neurological Death and Neurocognitive Impairment. A systematically review of the pertinent literature was performed by using the Cochrane Register of Controlled Trials (CENTRAL/CCTR), MEDLINE, EMBASE, CINAHL and the ISRCTNR (International Standard Randomised Controlled Trial Number Register) databases. A total amount of 971 articles were encountered, including 19 Randomized Clinical Trials. High bias risk studies were excluded based on the Cochrane Bias Risk Tool and 14 RCT with low bias risk were selected. The combination of surgical resection and Whole Brain Radiation Therapy resulted in longer overall survival than Whole Brain Radiation Therapy alone. The combination of Whole Brain Radiation Therapy and Stereotactic Radiosurgery resulted in better Local Control and Overall Survival than Whole Brain Radiation Therapy alone. Significative differences were not found in terms of Local Control and Overall Survive between the combination of Whole Brain Radiation Therapy plus Stereotactic Radiosurgery and Stereotactic Radiosurgery alone but Neurocognition was less affected in patients treated with Stereotactic Radiosurgery. Current studies that compare different therapeutic modalities for 1 to 4 brain metastases are not conclusive. The best treatment for patients with 1-4 brain metastases remains controversial.