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PURPOSE: Limited data are currently available on clinical outcomes after stereotactic body radiation therapy (SBRT) for pediatric and adolescent and young adult (AYA) patients with cancer. We aimed to perform a systematic review and study-level meta-analysis to characterize associated local control (LC), progression-free survival (PFS), overall survival, and toxicity after SBRT. METHODS AND MATERIALS: Relevant studies were queried using a Population, Intervention, Control, Outcomes, Study Design (PICOS)/Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Meta-analysis of Observational Studies in Epidemiology (MOOSE) selection criteria. Primary outcomes were 1-year and 2-year LC as well as incidence of acute and late grade 3 to 5 toxicities, with secondary outcomes of 1-year overall survival and 1-year PFS. Outcome effect sizes were estimated with weighted random effects meta-analyses. Mixed-effects weighted regression models were performed to examine potential correlations between biologically effective dose (BED10), LC, and toxicity incidence. RESULTS: Across 9 published studies, we identified 142 pediatric and AYA patients with 217 lesions that were treated with SBRT. Estimated 1-year and 2-year LC rates were 83.5% (95% confidence interval, 70.9%-96.2%) and 74.0% (95% CI, 64.6%-83.4%), respectively, with an estimated acute and late grade 3 to 5 toxicity rate of 2.9% (95% CI, 0.4%-5.4%; all grade 3). The estimated 1-year OS and PFS rates were 75.4% (95% CI, 54.5%-96.3%) and 27.1% (95% CI, 17.3%-37.0%), respectively. On meta-regression, higher BED10 was correlated with improved 2-year LC with every 10 Gy10 increase in BED10 associated with a 5% improvement in 2-year LC (P = .02) in sarcoma-predominant cohorts. CONCLUSIONS: SBRT provided durable LC for pediatric and AYA patients with cancer with minimal severe toxicities. Dose escalation may result in improved LC for sarcoma-predominant cohorts without a subsequent increase in toxicity. However, further investigations with patient-level data and prospective inquiries are indicated to better define the role of SBRT based on patient and tumor-specific characteristics.

Objectives: To perform a systematic review and meta-analysis of outcomes for patients with locally recurrent brain metastases treated with a repeat course of stereotactic radiosurgery (rSRS). Method: Primary outcomes were 1-year local control(LC) and radionecrosis (RN). Secondary outcomes were 1-year overall survival (OS) and 1-year distant brain control (DBC). Weighted random effects meta-analyses utilizing the DerSimonian and Laird methods were conducted to characterize summary effect sizes. Mixed effects regression models were utilized to analyze potential correlations between prognostic factors and outcomes. Results: In total, 347 patients with 462 brain metastases treated with rSRS were included. Estimated 1-year LC, OS, and DBC rates were 69.0% (95% CI: 61.0-77.0%), 49.7% (95% CI: 28.9-70.6%), and 41.6% (95% CI: 33.0-50.4%), respectively. The estimated RN rate was 16.1% (95% CI: 6.3-25.9%). Every 1 Gy increase in prescription dose was estimated to result in roughly 5% increase in 1-year LC (p = 0.14). Conclusions: rSRS was well-tolerated with reasonable 1-year LC and OS. Dose escalation may result in improved LC. [ABSTRACT FROM AUTHOR]