Intra-cavitary radiotherapy for surgically resected brain metastases: a comprehensive analysis including an individual patient data meta-analysis of intraoperative radiotherapy (IORT) and brachytherapy (IBT).

Alexandru Guranda, Erdem Güresir, Arne Mathias Ruder, Frank Anton Giordano, Johannes Wach

Abstract readMeta-AnalysisSystematic Review

In one paragraph

Synthesis in Journal of neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in

1citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

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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

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

Evaluation of an acrylic acid hydrogel dosimeter for 3-D dose verification in radiotherapy using MRI.PloS one · 2026
Article

4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Alexandru GurandaDepartment of Neurosurgery, University of Leipzig Medical Center, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany. alexandru.guranda@medizin.uni-leipzig.de.ORCID http://orcid.org/0000-0001-8319-0847

Erdem GüresirDepartment of Neurosurgery, University of Leipzig Medical Center, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.ORCID http://orcid.org/0000-0001-5243-4781

Arne Mathias RuderDepartment of Radiation Oncology, Medical Faculty Mannheim, University Medicine Mannheim, Heidelberg University, 68167, Mannheim, Germany.

Frank Anton GiordanoDepartment of Radiation Oncology, Medical Faculty Mannheim, University Medicine Mannheim, Heidelberg University, 68167, Mannheim, Germany.ORCID http://orcid.org/0000-0002-4680-0412

Johannes WachDepartment of Neurosurgery, University of Leipzig Medical Center, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSurgical resection followed by adjuvant radiotherapy is a standard approach for brain metastases (BM). Intracavitary radiotherapy techniques-namely intraoperative radiotherapy (IORT) and brachytherapy (IBT)-have gained attention as alternatives to stereotactic radiotherapy, potentially reducing neurotoxicity and treatment delays. However, robust comparative data remain scarce.

methodsWe performed a systematic meta-analysis including both conventional and reconstructed individual patient data (IPD) from studies reporting outcomes after intracavitary radiotherapy post-BM resection. Primary endpoint was local control rate (LCR); secondary endpoints included overall survival (OS), distant brain control (DBC), radiation necrosis (RN), and leptomeningeal disease (LMD). IPD was reconstructed from published Kaplan-Meier curves. Survival and incidence outcomes were pooled using random-effects models in R.

resultsTwenty-three studies with 858 patients were analyzed. The 1-year LCR was 96% (95% CI: 94-98%) for IORT and 95% (95% CI: 92-97%) for IBT. Median OS in patients who underwent IORT was 39.1 months (95% CI: 22.0-59.5), and 15.9 months (95% CI: 12.6-19.9) in whose who underwent IBT, respectively (p = 0.004; HR 0.64). IORT was associated with lower RN (4% vs. 7%) and LMD (6% vs. 9%). The 1-year DBC rate was higher for IORT (57%) than IBT (48%).

conclusionsIntracavitary radiotherapy yields excellent local control after BM resection. This IPD meta-analysis provides the most comprehensive evidence to date and supports further prospective evaluation of IORT in neuro-oncological care.

Indexed as

BrachytherapyBrain NeoplasmsIntraoperative CareHumansBrachytherapyBrain metastasesIndividual patient data meta-analysisIntraoperative radiotherapyLocal controlRadiation necrosis

Identifiers

PMID40960669

DOI10.1007/s11060-025-05227-2

PMCPMC12511155

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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.