Stereotactic Radiosurgery for Intracranial Metastases from Pediatric Solid Malignancies: A Systematic Review of the Literature

Abstract

Background

Stereotactic radiosurgery (SRS) for intracranial metastases from solid malignancies is widely used to improve local control in adult patients. Intracranial metastases from solid malignancies are rare in paediatric patients, and treatment can depend on multiple factors including tumour type, suitability for resection and systemic treatment options.

Objective

To summarise the available evidence on SRS for brain metastases from paediatric solid malignancies.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two databases (PubMed and EMBASE) were queried for SRS for brain metastases from paediatric solid malignancies published from 1980 to 2023.

Results

Out of the 55 records, three studies, two case reports, one case series of four patients and one patterns of practice survey met the inclusion criteria.

A meta-analysis of the results was not able to be performed due to the small number of patients, varied tumour pathologies, different radiotherapy treatment regimens and lack of radiotherapy details. The most common histologies were sarcomas and neuroblastoma.

The largest study had fifty-four paediatric patients with brain metastasis from solid malignancy, seven of these patients had SRS as part of their initial treatment. However, the efficacy and toxicity of these specific cases were not reported. In the few studies/reports when efficacy and toxicity is reported, SRS for brain metastases in paediatric patient appears to have good local control and is well tolerated.

Conclusion

Our systematic review suggests that there is a role for SRS in the management of brain metastases of paediatric solid malignancies. The limited literature highlight that for most paediatric solid malignancies, patients with brain metastases have a poor prognosis with few long-term survivors. Further studies with larger cohorts are needed to determine which paediatric patients with brain metastases benefit from SRS.