A Systematic Review and Meta-Analysis of Radiation Necrosis Incidence in Brain Metastasis Treated by Gamma Knife and CyberKnife Stereotactic Radiosurgery.
Publication/Presentation Date
8-20-2025
Abstract
BACKGROUND: Brain metastases from non-CNS malignancies are increasingly common due to enhanced screening and treatment. Stereotactic radiosurgery (SRS), including Gamma Knife (GK) and CyberKnife (CK), is preferred over whole brain radiation therapy for solitary or oligometastatic brain metastases. Radiation necrosis (RN) is a significant complication. This systematic review compares RN incidence after GK-SRS and CK-SRS.
METHODS: Following PRISMA guidelines, we searched PubMed, MEDLINE, EMBASE, and Web of Science using terms like "Gamma Knife," "CyberKnife," and "radiation necrosis." Included studies reported RN in adults treated with GK-SRS or CK-SRS. Data on patient numbers, lesion size, SRS dosage, RN incidence, and follow-up were extracted. A random-effects meta-analysis was conducted, with heterogeneity assessed via Higgins' I
RESULTS: From 5,245 articles (3,562 GK, 1,683 CK), 52 studies (37 GK, 15 CK) with 9,186 patients were analyzed. Pooled RN incidence was 7.5% (95% CI: 5.8-9.7%) for GK-SRS and 6.8% (95% CI: 4.5-10.1%) for CK-SRS (p=0.6659). High heterogeneity (I
CONCLUSIONS: GK-SRS and CK-SRS show comparable RN incidence, but heterogeneity and bias limit conclusions. Standardized diagnostics and prospective studies are needed.
First Page
124390
Last Page
124390
ISSN
1878-8769
Published In/Presented At
Walker, H. B., Meave-Casey, K., Ricci, S., Kanuparthi, P., Ziechmann, R., Miyamoto, C., Weaver, M., & Erkmen, K. (2025). A Systematic Review and Meta-Analysis of Radiation Necrosis Incidence in Brain Metastasis Treated by Gamma Knife and CyberKnife Stereotactic Radiosurgery. World neurosurgery, 124390. Advance online publication. https://doi.org/10.1016/j.wneu.2025.124390
Disciplines
Medicine and Health Sciences
PubMedID
40845947
Department(s)
Fellows and Residents
Document Type
Article