Whole-brain radiotherapy with simultaneous integrated boost in treatment of patients with brain metastases: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis compared whole-brain radiotherapy with simultaneous integrated boost (WBRT-SIB) against WBRT alone for patients with brain metastases. Across 30 studies involving 2,033 patients, WBRT-SIB was associated with improved overall survival (HR = 0.7, 95%CI 0.5-0.96, p = 0.03), intracranial progression-free survival, and intracranial local progression-free survival. The survival benefit was mainly observed in patients with small-cell lung cancer; no significant effect was found for other tumour types. The analysis found no increased risk of treatment-related adverse events.

Key findings

• Compared with WBRT alone, WBRT-SIB improved overall survival (HR = 0.7, 95%CI 0.5-0.96, p = 0.03).
• WBRT-SIB improved intracranial progression-free survival (HR = 0.67, 95%CI 0.47-0.96, p = 0.03) and intracranial local progression-free survival (HR = 0.55, 95%CI 0.4-0.79, p < 0.01).
• The survival benefit was mainly driven by patients with small-cell lung cancer (HR = 0.54, 95%CI 0.31-0.92, p = 0.025); no significant effect was observed for other tumour types.
• WBRT-SIB did not increase treatment-related adverse events; radiation necrosis incidence was 5.05% (95%CI 1.19%-10.77%).

Why it matters

For patients with multiple brain metastases who are not candidates for focal treatment, intracranial control and survival are important outcomes. This pooled evidence suggests WBRT-SIB may improve these outcomes without an observed increase in treatment-related adverse events, although the apparent survival benefit is concentrated in small-cell lung cancer. The findings help frame which patients may warrant further evaluation of this approach.

What to keep in mind

The abstract does not describe the designs or quality of the included studies, limiting assessment of how confidently pooled associations can be interpreted.