Table 5. Grading of recommendations, assessment, development and evaluation (GRADE) evidence quality ratings for survival outcomes.

The quality of evidence assessments was performed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system [22]. Abbreviations: SRS = stereotactic radiosurgery.

	Median survival	Six-month survival	12-month survival
Studies demonstrating significant improvement	2/4	2/4	2/4
SRS and Ipilimumab patients	89	89	89
SRS alone patients	133	133	133
Initial quality of evidence	Low (two plus)	Low (two plus)	Low (two plus)
Risk of bias	Serious  (-1)	Serious  (-1)	Serious  (-1)
Inconsistency	Not serious	Not serious	Not serious
Indirectness	Not serious	Not serious	Not serious
Imprecision	Serious  (-1)	Serious  (-1)	Serious  (-1)
Publication bias	Not likely	Not likely	Not likely
Large effect	Large  (+1)	Large  (+1)	Large  (+1)
Dose response	No gradient	No gradient	No gradient
All plausible residual confounding	Would reduce effect (+1)	Would reduce effect (+1)	Would reduce effect (+1)
GRADE  overall quality of evidence	Low (two plus)	Low (two plus)	Low (two plus)