[Stereotactic radiosurgery in benign tumors of the central nervous system]
Merlotti L, Ciapponi A, Alfie V, Latorraca M, Augustovski F, Garcia Marti S, Pichon Riviere A, Alcaraz A, Bardach A
Record ID 32018013777
Spanish
Original Title:
RadiocirugĂa estereotáctica en tumores benignos del sistema nervioso central
Authors' recommendations:
Low-quality evidence suggests that stereotactic radiosurgery for benign tumors of the central nervous system that are difficult to access by surgery (due to their intracranial location or proximity to critical structures) or in patients who are not eligible for surgery, can provide substantial benefits. This approach allows for adequate tumor control and a 5-year progression-free survival rate ranging from 70% to 90%. However, it is crucial to consider the most commonly reported adverse effects associated with this technology, such as brain edema and neurological impairment due to radiation. These adverse events have been more commonly observed when treating vestibular schwannomas.
Low-quality evidence suggests that stereotactic radiosurgery in surgically accessible benign tumors of the central nervous system (and in patients who are not contraindicated for surgery), when compared to active surveillance, conventional radiotherapy, or surgery, may offer a lower clinical benefit. Stereotactic radiosurgery would maintain tumor control and 5-year progression-free survival rates similar to those achieved with other technologies.
However, when compared to conventional radiotherapy, it results in fewer secondary adverse effects due to less radiation exposure of the surrounding healthy tissue. When compared with surgery or microsurgery, it is also a less invasive technique.
The clinical practice guidelines identified that mention the use of stereotactic radiosurgery indicate that it should be evaluated considering several factors: tumor size (recommending its use for small to medium-size tumors), the location of the intracranial lesion (preferably for tumors that are difficult to access using standard surgical techniques), proximity to critical structures, pre-intervention neurological involvement (such as auditory assessment in vestibular schwannomas), and tumor characterization through standard imaging methods.
As regards coverage policies, public health funders from Germany and the United Kingdom, and private health funders from the United States provide coverage for certain types of tumors in selected patients. Latin American health funders do not mention this technology. In Argentina, it is covered by the Mandatory Medical Program. No economic studies conducted in the region have been identified. In Argentina, the cost-effectiveness of this technology could not be determined either.
Details
Project Status:
Completed
Year Published:
2024
URL for published report:
https://ets.iecs.org.ar/publication/2244
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Argentina
MeSH Terms
- Radiosurgery
- Nervous System Neoplasms
- Pituitary Neoplasms
- Brain Neoplasms
Contact
Organisation Name:
Institute for Clinical Effectiveness and Health Policy
Contact Address:
Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA
Contact Name:
info@iecs.org.ar
Contact Email:
info@iecs.org.ar
Copyright:
<p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.