COMPARING MICROSURGERY AND RADIOSURGERY FOR BRAIN METASTASES

Introduction: Brain metastases are among the most common intracranial tumors. It is estimated that 20%-40% of cancer patients will develop brain metastasis. Higher rates of brain metastasis at diagnosis present with small and non-small cell lung cancer (16% and 10.3%, respectively). Conversely, melanoma, kidney cancer, breast and colorectal cancer patients present with lower rates (1.5%, 1.3%, 0.3% and 0.3%, respectively). Methods: A systematic review was conducted following PRISMA guidelines in PubMed and Scopus databases, for original studies published between January 2015–2025, in English, French, and German. These compare neurosurgical operations and radiosurgery in adult patients with brain metastases, reporting on at least one of the following outcomes: overall survival, progression-free survival, local tumor control, complication rates, or quality of life. Case reports, reviews, letters to the editor, grey literature, or annals from congresses will be excluded. Objective: To optimize treatment strategy, one must understand the comparative survival outcomes, local tumor control, complication rates, and quality of life of microsurgical approach and radiosurgery. Results: The initial search yielded a total of 686 studies (617 and 69 articles from Pubmed and Scopus, respectively). After screening titles and abstracts, 52 duplicates were removed, and 482 studies were deemed potentially eligible for full-text review. Among these, 238 studies met the inclusion criteria. Preliminary data suggest that microsurgical resection provides superior local tumor control in patients with solitary, accessible metastases, while radiosurgery is associated with fewer complications and is more effective with multiple lesions or poor performance status. However, both modalities demonstrated comparable overall survival rates. Conclusions: In conclusion, the decision for microsurgery or radiosurgery depends on several factors and can be categorized into tumor-related factors, patient-related factors and treatment-related factors. The proper timing for decision-making remains a debatable matter, while the survival rates between microsurgery and stereotactic radiosurgery don’t differ significantly statistically.