Gamma Knife radiosurgery as primary treatment of low-grade brainstem gliomas: A systematic review and metanalysis of current evidence and predictive factors

Crit Rev Oncol Hematol. 2021 Dec:168:103508. doi: 10.1016/j.critrevonc.2021.103508. Epub 2021 Oct 19.


The current standard of care for surgically inaccessible low-grade brainstem gliomas (BS-LLGs) is external-beam radiotherapy (RT). Developments toward more innovative conformal techniques have focused on decreasing morbidity, by limiting radiation to surrounding tissues. Among these Gamma Knife radiosurgery (SRS-GK) has recently gained an increasingly important role in the treatment of these tumors. Although SRS-GK has not yet been compared with conventional RT in patients harboring focal BS-LGGs, clinical practice has been deeply influenced by trials performed on other tumors. This is the first meta-analysis on the topic, systematically reviewing the most relevant available evidence, comparing RT and SRS-GK as primary treatments of BS-LGGs, focusing on survival, clinical outcome, oncological control, and complications. Predictive factors have been systematically evaluated and analyzed according to statistical significance and clinical relevance.

Keywords: Gamma Knife; Low-grade brainstem gliomas; Radiotherapy; Stereotactic radiosurgery.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Brain Neoplasms* / surgery
  • Brain Stem Neoplasms* / radiotherapy
  • Brain Stem Neoplasms* / surgery
  • Glioma* / radiotherapy
  • Glioma* / surgery
  • Humans
  • Radiosurgery*
  • Retrospective Studies
  • Treatment Outcome