The safety and efficacy of robotic radiosurgery and radiotherapy in the management of skull base tumors: a systematic review and meta-analysis.

Stereotactic radiosurgery (SRS) and radiotherapy (SRT) have gained prominence as both adjuvant and primary treatment options for patients with skull base tumors that are either inoperable or present as residual or recurrent lesions post-surgery. The object of the current study is to evaluate the safety and efficacy of robotic-assisted SRS and SRT across various skull base pathologies. The study was conducted under PRISMA guidelines and involved a comprehensive evaluation of databases, including PubMed, Scopus, Embase, Web-of-Science, and the Cochrane Library. The data collection period was extended up to 30 September. Statistical analyses were executed using Comprehensive Meta-Analysis software. Furthermore, Cochran's Q test assessed statistical heterogeneity within the findings. From an initial pool of 1,792 articles, 69 studies were included in the systematic review, with 60 qualifying for meta-analysis, encompassing 3,046 participants. Meta-analysis revealed tumor control rates were significantly enhanced with the use of CyberKnife (95% CI: 0.901-0.928, p < 0.001) and robotic Gamma Knife radiosurgery (GKRS) (95% CI: 0.897-0.959, p < 0.001). Meningiomas and schwannomas exhibited higher treatment responsiveness (ES: 0.960 and 0.949, respectively), whereas chordomas displayed lower responsiveness (ES: 0.743). The overall major adverse event rate was between 5.6% and 8.3% (95% CI: 0.056-0.083, p < 0.001). Adverse events exhibited a higher incidence in patients with adenomas (95% CI: 0.122-0.217, p < 0.001), while they were least prevalent in those with schwannomas (95% CI: 0.019-0.041, p < 0.001). Robotic SRS and SRT, employing both gamma-knife and cyber-knife, have demonstrated promising outcomes characterized by high efficacy and safety in managing various skull base tumors.