An evidence-based medicine review of stereotactic radiosurgery.

BACKGROUND

Stereotactic radiosurgery has been increasingly utilized to manage a wide variety of indications including vascular malformations, benign and malignant tumors, and functional disorders.

METHODS

Review of the recent literature on stereotactic radiosurgery by evidence-based standards.

RESULTS

The vast majority of published papers on stereotactic radiosurgery is of rather poor quality (level 3 or below). Two studies provide level 1 evidence showing an improvement in local tumor control or survival for patients with 1-3 brain metastases having radiosurgery in conjunction with whole brain radiation therapy when compared to patients having whole brain radiation therapy alone. One randomized trial found no improvement in facial pain outcomes for trigeminal neuralgia patients having a longer segment of the nerve irradiated.

CONCLUSION

For a variety of reasons it is unlikely that randomized clinical trials will be performed to evaluate the clinical usefulness of stereotactic radiosurgery. Nonetheless, the preponderance of level 3 information supports the role of radiosurgery as either an adjunct or alternative to surgical resection or fractionated radiation therapy.