Evidence map›Paper›PMID 42213221›Full record

SynthesisJournal of neuro-oncology2026

Radiotherapeutic management of metastatic brain disease: a two-decade meta-analysis of tumor control and neurocognitive outcomes with SRS alone versus SRS plus WBRT.

Pavel S Pichardo-Rojas, Fabricio Garcia-Torrico, Edwin A Andrade-Arbaiza, Luisa Fernanda Calderón Magdaleno, Arturo Ortiz, Miguel Angel Rodriguez Romero, Cristian Palomino-Ojeda, Mahesh Bekal, Ashish H Shah, Jason Sheehan and 1 more

Abstract readComparative StudyMeta-Analysis
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In one paragraph

Synthesis in Journal of neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Pavel S Pichardo-RojasDepartment of Neurosurgery, The Mount Sinai Hospital, New York, NY, USA.
Fabricio Garcia-TorricoUniversidad Mayor de San Andrés, La Paz, Bolivia.
Edwin A Andrade-ArbaizaUniversidad de El Salvador, Facultad Multidisciplinaria Oriental, San Miguel, El Salvador.
Luisa Fernanda Calderón MagdalenoFacultad de Ciencias, Universidad Nacional Autónoma de México, Ciudad de México, México.
Arturo OrtizUniversidad Autónoma de Tamaulipas, Facultad de Medicina Humana de Matamoros, Tamaulipas, México.
Miguel Angel Rodriguez RomeroUniversidad Autónoma del Estado de México, Toluca, Estado de México, México.
Cristian Palomino-OjedaFacultad de Ciencias de la Salud, Universidad Espíritu Santo, Samborondón, Ecuador.
Mahesh BekalVivian L. Smith Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
Ashish H ShahDepartment of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
Jason SheehanDepartment of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Yoshua EsquenaziVivian L. Smith Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA. Yoshua.EsquenaziLevy@uth.tmc.edu.ORCID http://orcid.org/0000-0002-9757-1453

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionBrain metastases represent the most common intracranial tumors in adults. Stereotactic radiosurgery (SRS) is widely used for their management. However, the role of SRS plus adjunct whole-brain radiotherapy (WBRT), remains debated given the risk of neurocognitive deterioration (NCD). We conducted a comparative analysis of SRS alone versus SRS combined with WBRT in patients with brain metastases.

methodsWe identified studies evaluating SRS alone or in combination with WBRT for the management of brain metastases. Our outcomes of interest included NCD, Overall Survival (OS), Local Tumor Control (LTC), and radionecrosis (RN).

resultsWe analyzed 6 cohort studies and 4 randomized controlled trials including 1,757 patients. OS was comparable between groups (HR = 1.06;95%CI = 0.86-1.30;p = 0.60). LTC in the SRS-alone group was 77.71%, while SRS+WBRT group achieved a 87.25% of LTC which was comparable between groups (RR = 1.17;95%CI = 0.99-1.39;p = 0.07;I

conclusionSRS is an effective and safe therapy for metastatic brain disease. While its combination with WBRT may improve recurrence rates with stable LTC and limited RN rates, it is associated with higher rates of NCD without a clear OS benefit. Future trials should assess homogeneous populations and integrate quality-of-life outcomes to guide individualized treatment selection. CLINICAL TRIAL NUMBER: Not applicable.

Indexed as

Brain NeoplasmsCranial IrradiationRadiosurgeryCombined Modality TherapyHumansTreatment OutcomeBrain metastasesLocal tumor control (LTC)Neurocognitive deterioration (NCD)OligometastasesOverall survival (OS)Radionecrosis (RN)Stereotactic radiosurgery (SRS)Whole brain radiotherapy (WBRT)

Identifiers

PMID42213221

What OpenQuestion holds

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Registered trials

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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.