Stereotactic radiosurgery versus whole-brain radiotherapy in melanoma brain metastasis: A systematic review and meta-analysis

Abstract

Background: Melanoma is an aggressive malignancy with a propensity towards the brain, with brain metastases (BM) clinically diagnosed in 40–50% of metastatic cases and the main cause of mortality and morbidity among patients with metastatic melanoma. The aim of this study was to discover any significant difference in overall survival and disease recurrence between SRS and WBRT.
Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from 2000 to October 2023 included (last search date 2nd November 2023). Meta-Analysis was performed using R studio.
Results: Of the 128 articles identified, a total of 19 studies were included in the analysis (2617 patients- 1117 WBRT & 1500 SRS). The median overall survival for patients that underwent WBRT was 4.4 months compared to 7.8 months for patients that underwent SRS. A Wilcox rank sum test was conducted and a significant difference in overall survival was found between the two groups (p<0.05) with a Wilcox value of, W= 27.5. Random-effect meta-analysis of recurrence failed to reach a statistically significant result, though showing a trend of increased risk for recurrence in patients treated with SRS (RR= 0.63, CI: 0.37-1.06, p=0.61). Number of patients with neurocognitive decline was also recorded; however only 6/19 studies reported it: 39/127 (31%) in WBRT and 21/52 (40%) in SRS patients.
Conclusions: This is the first systematic review and meta-analysis discussing the efficacy and safety of WBRT versus SRS in metastatic brain melanoma. Although SRS may increase the risk of recurrence, it appears to offer significant increase in overall survival compared to WBRT. Furthermore, when considering the safety profile of WBRT, it may prove as a superior treatment modality even when accounting for cofounders. Further randomised controlled trials will need to be conducted to formalise a treatment pathway for these patients with poor prognosis.