SADA-18 BRACHYTHERAPY FOR RECURRENT BRAIN METASTASES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OUTCOMES
TL;DR
In patients with recurrent BM, intracranial brachytherapy is associated with high rates of local control, supporting its role as a focal salvage strategy in carefully selected patients and underscores the need for prospective studies to better define patient selection and optimize integration with novel systemic therapies.
Abstract
Abstract Background Management of recurrent brain metastases (BM) remains a major clinical challenge, with limited effective salvage options and an increased risk of toxicity with re-irradiation. Intracranial brachytherapy has re-emerged as a focal treatment strategy, enabling localized dose escalation while minimizing exposure to previously irradiated brain tissue. We performed a systematic review and meta-analysis to evaluate outcomes of brachytherapy in this high-risk setting. Methods A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted to identify studies reporting outcomes of intracranial brachytherapy for recurrent BM. Eligible studies included patients treated with brachytherapy in the salvage setting following prior radiation. The primary outcome was 1-year local control (LC) and overall survival (OS). Secondary outcome was radiation necrosis (RN). Pooled estimates were calculated using a random-effects model with logit transformation for proportions. Results A total of five studies comprising 74 patients and 102 lesions were included. The median age was 58.6 years (range: 56-64). The median number of implanted seeds was 16 (range, 10–19), and the median tumor volume was 9.5 cc (range, 3.23–9.6). The median follow-up was 13.2 months (range: 9.3-19.2) The pooled 1-year LC rate was 86.8% (95% CI: 78.4–92.3; I²=0%), demonstrating consistent local control across studies. The pooled 1-year OS rate was 53.1% (95% CI: 32.0–73.2; I²=68.3%), indicating substantial heterogeneity likely reflecting differences in patient selection, tumor histology, and prior treatments. The pooled RN rate was 13.29% (95% CI: 5.58-28.41; I2=53.6%). Conclusions In patients with recurrent BM, intracranial brachytherapy is associated with high rates of local control, supporting its role as a focal salvage strategy in carefully selected patients. The observed heterogeneity in survival outcomes underscores the need for prospective studies to better define patient selection and optimize integration with novel systemic therapies.