Summary of findings for the main comparison. Surgery plus whole brain radiotherapy (WBRT) compared to stereotactic radiosurgery for people with single or solitary brain metastasis.
| Surgery plus whole brain radiotherapy (WBRT) compared to stereotactic radiosurgery for adults with single or solitary brain metastasis | ||||||
| Patient or population: people with single or solitary brain metastasis Setting: hospital Intervention: surgery plus WBRT Comparison: stereotactic radiosurgery | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with stereotactic radiosurgery | Risk with surgery plus WBRT | |||||
| Overall survival follow‐up: mean 12 months | Study population | HR 0.92 (0.48 to 1.77) | 64 (1 RCT) | ⊕⊝⊝⊝ VERY LOWa | ||
| 515 per 1000 | 486 per 1000 (294 to 720) | |||||
| Adverse events follow‐up: mean 12 months | Study population | RR 0.31 (0.07 to 1.44) | 64 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb | ||
| 194 per 1000 | 60 per 1000 (12 to 277) | |||||
| Adverse events (moderate) follow‐up: mean 12 months | Study population | RR 0.62 (0.11 to 3.50) | 64 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb | ||
| 61 per 1000 | 38 per 1000 (7 to 212) | |||||
| Adverse events (severe) follow‐up: mean 12 months | Study population | RR 0.13 (0.00 to 2.50) | 64 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Progression‐free survival: not measured | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Quality of life (HRQoL) assessed with: QLQ‐C30 follow‐up: mean 6 months | Even though there was an improvement in scores for the domains 'role functioning' and 'quality of life' six weeks after stereotactic radiosurgery (reported only as P < 0.05), the difference was lost six months after treatment. Numeric results were not reported | ‐ | (1 RCT) | ⊕⊝⊝⊝ VERY LOWb | ||
| *The risk in the intervention group (and its 95% CI) 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; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: 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 certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect | ||||||
aDowngraded by two levels due to risk of bias issues (high risk of selection bias) and imprecision. bDowngraded by two levels due to risk of bias issues (high risk of selection, performance and attrition bias) and imprecision.