Twenty-seven trials were included in the review (total number of participants unclear). Jadad scores ranged from 1 to 4. Four of the 27 trials involved patients with single brain metastases, one involved patients with one to three metastases and the rest involved patients with multiple metastases.
For patients with single brain metastasis, surgical excision combined with whole brain radiotherapy did not improve survival compared with whole brain radiotherapy alone (three trials). Postoperative whole brain radiotherapy reduced intracranial recurrence, but did not improve survival compared with surgery alone (one trial). For patients with multiple metastases, altered dose fractionation schedules of whole brain radiotherapy did not improve survival compared with a standard schedule (nine trials) and addition of radiosensitizers did not improve survival or response (five trials). Whole brain radiotherapy and radiosurgery boost did not improve survival over whole brain radiotherapy alone in patients with multiple metastases (three trials), but a benefit was reported in one trial for patients with a single metastasis. In one trial, whole brain radiotherapy plus supportive care increased median survival compared with supportive care alone (14 versus 10 weeks), but the statistical significance of the result was uncertain. Results for other outcomes (including toxicity) and comparisons were reported.