Pre-operative stereotactic radiosurgery (SRS) and intraoperative cesium-131 (Cs-131) brachytherapy are alternatives to post-operative SRS for resected brain metastases (BMs). The randomized phase 3 Radiation One and Done Study (ROADS; NCT04365374) showed improved surgical-bed control with Cs-131 tiles versus post-operative stereotactic radiotherapy, but outcomes relative to pre-operative SRS are undefined.<\/p>\n
PubMed, Embase, and ScienceDirect were searched through October 2026 (PRISMA 2020); one further trial was identified by other methods. Twelve-month local control (LC), leptomeningeal disease (LMD), radiation necrosis (RN), and overall survival (OS) were extracted for treatment-na\u00efve BMs. Proportions were pooled with random-effects generalized linear mixed models and compared with a test for subgroup differences; sensitivity analyses included meta-regression, Hartung\u2013Knapp, leave-one-out, follow-up, and fractionation analyses.<\/p>\n
Fifteen pre-operative SRS studies (918 patients\/940 BMs) and four brachytherapy studies (207 patients\/217 BMs) were included. Pooled 12-month LC was 97% (95% CI 90\u201399) with Cs-131 brachytherapy and 90% (86\u201393) with pre-operative SRS (test for subgroup differences p<\/i> = 0.054; meta-regression p<\/i> = 0.019; Hartung\u2013Knapp p<\/i> = 0.066); among studies reporting observed counts, LC was 99% vs. 90% (p<\/i> = 0.009). Within pre-operative SRS, LC was 96% after hypofractionated and 86% after single-fraction treatment (p<\/i> = 0.005). LMD (9.1% vs. 5.1%) and RN (0.7% vs. 5.2%) did not differ significantly. Median OS was 15.6 months with brachytherapy (range 5.9\u201342.5; 11.0 months, range 5.9\u201320.1, excluding the ROADS estimate) and 14.4 months with pre-operative SRS (range 6.3\u201326.4).<\/p>\n","protected":false},"excerpt":{"rendered":"
Pre-operative stereotactic radiosurgery (SRS) and intraoperative cesium-131 (Cs-131) brachytherapy are alternatives to post-operative SRS for resected brain metastases (BMs). The randomized phase 3 Radiation One and Done Study (ROADS; NCT04365374) showed improved surgical-bed control with Cs-131 tiles versus post-operative stereotactic radiotherapy, but outcomes relative to pre-operative SRS are undefined. PubMed, Embase, and ScienceDirect were searched [\u2026]<\/p>\n","protected":false},"author":662,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,47],"tags":[],"class_list":["post-247347","post","type-post","status-publish","format-standard","hentry","category-biotech-medical","category-neuroscience"],"_links":{"self":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts\/247347","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/users\/662"}],"replies":[{"embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/comments?post=247347"}],"version-history":[{"count":0,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/posts\/247347\/revisions"}],"wp:attachment":[{"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/media?parent=247347"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/categories?post=247347"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lifeboat.com\/blog\/wp-json\/wp\/v2\/tags?post=247347"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}