Surgical resection versus stereotactic radiosurgery for the treatment of brain metastases in the motor cortex; a meta-analysis and systematic review

Brain metastasis in the motor cortex is a challenging condition to treat. Surgical resection or stereotactic radiosurgery (SRS)/hypofractionated stereotactic radiotherapy (hypoSRT) are valuable options up to now. Due to its unique location and potential for neurologic deficits, neither treatment is entirely satisfactory. There is still a lack of data on the treatment result of motor cortex metastasis. This study provides a comprehensive review and meta-analysis comparing surgery and SRS/hypoSRT for treating brain metastasis in the motor cortex. Core databases, including PubMed, Embase, and the Cochrane Library, were systematically searched for brain metastasis in the motor cortex, demonstrating the clinical outcomes of both surgery and SRS/hypoSRT. Motor power outcome and treatment-associated complication rates were thoroughly evaluated. Twenty-five articles were listed for full-text review. Among them, 13 articles were eligible for inclusion criteria: retrospective cohort studies comparing surgery and SRS/hypoSRT. There are 323 patients in the surgery group and 220 in the SRS/hypoSRT group. The motor outcome is better in surgery group, but without statistical significance (0.49 vs 0.37, p = 0.3937) and treatment-related complication is lower in surgery group with statistical significance (0.09 vs 0.26, p = 0.0218). Treatment modality should be tailored by the patient's performance status, history of radiation, presence of ongoing chemotherapy, or extracranial progression status.