Evidence map›Paper›PMID 25752382›Full record

SynthesisInternational journal of radiation oncology, biology, physics2015

Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis.

Arjun Sahgal, Hidefumi Aoyama, Martin Kocher, Binod Neupane, Sandra Collette, Masao Tago, Prakesh Shaw, Joseph Beyene, Eric L Chang

2 registry-linked trialsOpen access · hybridAbstract readMeta-AnalysisReview
PubMed Publisher
In one paragraph

Synthesis in International journal of radiation oncology, biology, physics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 184 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
184citing papers in PubMed, 5 pooled it
51.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03295916 early_phase1unknown statusnot on this mapstarted 2018, after this paper: background citation

Stereotactic Body Radiotherapy (SBRT) for the Treatment of OligoMetastasis in Breast Cancer Patients (STOMP): A Prospective Feasibility Trial

TypeinterventionalSponsorJuravinski Cancer CenterRan2018 to 2021Enrolled30ConditionsBreast CancerArmsStereotactic Body Radiotherapy
NCT05477316 naunknown statusnot on this mapstarted 2021, after this paper: background citation

A Single-arm Pilot Study, to Assess the Efficacy of Cerebellar IMRT Combined With Cerebral SRS in Patients With Brain Metastases That Are Predominantly in the Posterior Fossa - a Novel Treatment Approach

TypeinterventionalSponsorHadassah Medical OrganizationRan2021 to 2024Enrolled37ConditionsBrain Metastases, Posterior Fossa Lesion, Cerebral LesionArmsRadiation treatment
3 · Its place in the literature

Who cites it

184 citing papers in PubMed, 5 syntheses or guidelines pooled it, 420 citations in OpenAlex.

  1. Bridging surgery and radiotherapy: the role of stereotactic radiosurgery in pediatric brain tumor care.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2026
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  8. Radiosurgery with flattening-filter-free techniques in the treatment of brain metastases : Plan comparison and early clinical evaluation.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2016
    Trial
  9. Focused ultrasound for brain metastases.Neuro-oncology advances · 2026
    Review
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124 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 8 institutions in 5 countries.

Arjun SahgalDepartment of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: arjun.sahgal@sunnybrook.ca.
Hidefumi AoyamaDepartment of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Martin KocherDepartment of Radiation Oncology, University of Cologne, Cologne, Germany.
Binod NeupaneDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Sandra ColletteStatistics Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
Masao TagoDepartment of Radiology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.
Prakesh ShawDepartment of Pediatrics, Mount Sinai Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada.
Joseph BeyeneDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Eric L ChangDepartment of Radiation Oncology, University of Southern California, Los Angeles, California; Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
McMaster University · CAEuropean Organisation for Research and Treatment of Cancer · BEHealth Sciences Centre · CANiigata University · JPTeikyo University · JPThe University of Texas MD Anderson Cancer Center · USUniversity of Cologne · DEUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo perform an individual patient data (IPD) meta-analysis of randomized controlled trials evaluating stereotactic radiosurgery (SRS) with or without whole-brain radiation therapy (WBRT) for patients presenting with 1 to 4 brain metastases. METHOD AND MATERIALS: Three trials were identified through a literature search, and IPD were obtained. Outcomes of interest were survival, local failure, and distant brain failure. The treatment effect was estimated after adjustments for age, recursive partitioning analysis (RPA) score, number of brain metastases, and treatment arm.

resultsA total of 364 of the pooled 389 patients met eligibility criteria, of whom 51% were treated with SRS alone and 49% were treated with SRS plus WBRT. For survival, age was a significant effect modifier (P=.04) favoring SRS alone in patients ≤50 years of age, and no significant differences were observed in older patients. Hazard ratios (HRs) for patients 35, 40, 45, and 50 years of age were 0.46 (95% confidence interval [CI] = 0.24-0.90), 0.52 (95% CI = 0.29-0.92), 0.58 (95% CI = 0.35-0.95), and 0.64 (95% CI = 0.42-0.99), respectively. Patients with a single metastasis had significantly better survival than those who had 2 to 4 metastases. For distant brain failure, age was a significant effect modifier (P=.043), with similar rates in the 2 arms for patients ≤50 of age; otherwise, the risk was reduced with WBRT for patients >50 years of age. Patients with a single metastasis also had a significantly lower risk of distant brain failure than patients who had 2 to 4 metastases. Local control significantly favored additional WBRT in all age groups.

conclusionsFor patients ≤50 years of age, SRS alone favored survival, in addition, the initial omission of WBRT did not impact distant brain relapse rates. SRS alone may be the preferred treatment for this age group.

Indexed as

AdultAgedAged, 80 and overAge FactorsBrain NeoplasmsClinical Trials, Phase III as TopicCombined Modality TherapyCranial IrradiationFemaleHumansMaleMiddle AgedMultivariate AnalysisRadiosurgeryRandomized Controlled Trials as Topic

Identifiers

PMID25752382
OpenAlexW1995174703

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.