Summary of findings 1. Whole brain radiation therapy (WBRT) + stereotactic radiosurgery (SRS) versus WBRT for the treatment of brain metastases.
| Whole brain radiation therapy (WBRT) + stereotactic radiosurgery (SRS) versus WBRT for the treatment of brain metastases | ||||||
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Patient or population: people with brain metastases Settings: inpatient or outpatient Intervention: WBRT + SRS versus WBRT | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | WBRT + SRS versus WBRT | |||||
| Overall survival Follow‐up: 12 months1 | Study population | HR 0.82 (0.65 to 1.02) | 358 (2 studies2) | ⊕⊕⊕⊝ moderate3 | ||
| 762 per 1000 | 692 per 1000 (607 to 769) | |||||
| Medium‐risk population | ||||||
| 773 per 1000 | 704 per 1000 (619 to 780) | |||||
| Disease‐specific survival | Study population | RR 0.92 (0.64 to 1.32) | 286 (1 study2) | ⊕⊕⊕⊝ moderate3 | ||
| 309 per 1000 | 284 per 1000 (198 to 408) | |||||
| Medium‐risk population | ||||||
| 309 per 1000 | 284 per 1000 (198 to 408) | |||||
| Local tumor control Follow‐up: 12 months1 | Study population | HR 0.27 (0.14 to 0.52) | 129 (2 studies2) | ⊕⊕⊕⊝ moderate3 | ||
| 439 per 1000 | 145 per 1000 (78 to 260) | |||||
| Medium‐risk population | ||||||
| 644 per 1000 | 243 per 1000 (135 to 416) | |||||
| Functionally independent survival (KPS) Follow‐up: 6 months | Study population | RR 0.78 (0.61 to 1.00) | 145 (1 study2) | ⊕⊕⊕⊝ moderate3 | ||
| 725 per 1000 | 565 per 1000 (442 to 725) | |||||
| Medium‐risk population | ||||||
| 725 per 1000 | 565 per 1000 (442 to 725) | |||||
| Steroid use Follow‐up: 6 months | Study population | RR 0.64 (0.42 to 0.97) | 118 (1 study2) | ⊕⊕⊝⊝ low3 | ||
| 545 per 1000 | 349 per 1000 (229 to 529) | |||||
| Medium‐risk population | ||||||
| 546 per 1000 | 349 per 1000 (229 to 530) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HR: hazard ratio; KPS: Karnofsky Performance Status; RR: risk ratio; SRS: stereotactic radiosurgery; WBRT: whole brain radiation therapy | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
112 months was used to calculate baseline rates, since we used a HR in the main analysis. 2Downgraded to moderate quality of evidence because, "further research is very unlikely to change our confidence in the estimate of effect", may not be true. Evidence from more relevant trials would be welcome. 3Estimate is imprecise as there is a fair degree of uncertainty in the pooled estimate as indicated by 95% CI.