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Abstract
Introduction. The incidence of radionecrosis (RN) following stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) using linear accelerators (LINAC) or robotic delivery systems remains incompletely characterized. In contrast to data from gamma knife-based studies, the literature on these radiotherapy (RT) modalities remains limited. This may lead to inaccurate extrapolation of RN rates observed with gamma-based therapies to populations treated with LINAC or robotic techniques, potentially misrepresenting the true incidence of this disease.
Aim. To evaluate the incidence of RN following SRS/SRT delivered via LINAC or robotic systems in patients with brain metastases.
Materials and Methods. This meta-analysis included studies published between 2015 and 2025 identified through PubMed and ScienceDirect. The primary outcome was RN incidence per lesion and per patient. Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Statistical analysis was performed using Comprehensive Meta-Analysis software (v3/v4).
Results. Ten publications met inclusion criteria. Pooled analysis demonstrated RN incidence of 7.1 % (95 % CI: 4.1-12.2) per treated lesion and 10.5 % (95 % CI: 6.8-15.8) per patient using random-effects models.
Conclusion. When indirectly compared with gamma knife outcomes, LINAC and robotic SRS/SRT demonstrate comparable RN rates. However, more studies specifically evaluating these modalities in brain metastasis patients are needed to establish more precise estimates.
References
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