Interventional stereotactic radiotherapy (brachytherapy) for unresected brain metastases: Systematic review of outcome and toxicity.

Costantino Putzu, Paul Rogowski, Andrea Vavassori, Rupesh Kotecha, Federico Mastroleo, Giulia Marvaso, Barbara Alicja Jereczek-Fossa, Mateusz Bilski, Łukasz Kuncman, Stefano Durante, Artur Chyrek, Bruno Fionda, Luca Tagliaferii, Jacek Fijuth, Ranjini Tolakanahalli

Journal: Critical reviews in oncology/hematology 2025;212():104777

PMID: 40425133

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Abstract

BACKGROUND

Stereotactic brachytherapy (SBT) is an underutilized treatment for brain metastases. This systematic review evaluates SBT's clinical outcomes, toxicity, and procedural characteristics for intact brain metastases in radiation-naive and radiation-recurrent patients.

METHODS

A systematic review was conducted following PRISMA guidelines and the PICOS framework. Studies published until June 30, 2024, were identified through searches of PubMed, Scopus, Web of Science, and Cochrane databases. Retrospective studies and prospective trials were included. Key extracted data included patient characteristics, treatment protocols, local control (LC), distant-intracranial control (DIC), overall survival (OS), and procedure-related toxicity. The risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

Eight retrospective single-center studies involving 427 patients and 456 metastases met inclusion criteria. Median patient age ranged from 47 to 60 years, with most having a Karnofsky Performance Status ≥ 70. SBT mostly demonstrated high 1-year LC rates (93.3 %-100 %) and a 1-year DIC from 52 % to 90 %. Median OS for radiation-naive patients ranged from 8 to 17 vs. 6-28.4 months for radio-recurrent patients, with RPA class 1 showing the best outcomes. Toxicity was minimal, with no reported fatal complications or significant late toxicity. Across all studies, I-125 seeds were utilized, with temporary implantation predominating, while permanent implantation involved higher doses, up to 150 Gy, and extended treatment durations. Postoperative morbidity within 30 days ranged from 0 % to 6.6 % across different studies. No G3/G4 acute toxicities were reported.

CONCLUSIONS

SBT is a highly effective and safe option for treating intact brain metastases, particularly in patients with large or radiation-recurrent lesions.

Address: Department of Brachytherapy, Saint John's Cancer Center, Lublin, Poland; Department of Radiotherapy, Medical University of Lublin, Lublin, Poland; Department of Radiotherapy, Saint John's Cancer Center, Lublin, Poland. Electronic address: [email protected].; Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: [email protected].; Department of Radiotherapy, Medical University of Lodz, Poland; Department of External Beam Radiotherapy, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Poland. Electronic address: [email protected].; Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, Munich 81377, Germany. Electronic address: [email protected].; Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: [email protected].; Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: [email protected].; Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland; Electroradiology Department, Poznan University of Medical Science, Poznań, Poland. Electronic address: [email protected].; Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: [email protected].; UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Electronic address: [email protected].; UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: [email protected].; Department of Radiotherapy, Medical University of Lodz, Poland; Department of External Beam Radiotherapy, Copernicus Memorial Hospital in Lodz Comprehensive Cancer Center and Traumatology, Poland.; Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: [email protected].; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States. Electronic address: [email protected].; Division of Radiation Oncology, European Institute of Oncology IRCCS, Milan 20141, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: [email protected].; Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States.

DOI: 10.1016/j.critrevonc.2025.104777