Objective:

To evaluate the efficacy and safety of IORT and IBT following surgical resection of brain metastases, focusing on local control, distant brain failure, overall survival, treatment-related toxicity, and cognitive outcomes.

Key Findings:

• IORT and IBT show promising 1-year local control rates of 85–96%, significantly improving local control compared to surgery alone.
• The study included 23 studies with a total of 858 patients treated with IORT or IBT, highlighting their potential as effective alternatives to traditional therapies.

Interpretation:

IORT and IBT are effective local treatment options for brain metastases post-surgery, offering improved local control and potentially better cognitive outcomes compared to traditional whole-brain radiotherapy.

Limitations:

• Non-randomization and selection bias in included studies may affect the reliability of the findings.
• Heterogeneity in study designs and patient populations limits the generalizability of the results.
• Inconsistent reporting of Karnofsky Performance Status (KPS) may impact outcome assessments.

Conclusion:

IORT and IBT represent viable alternatives to whole-brain radiotherapy for patients with resected brain metastases, warranting further investigation to optimize treatment protocols and address identified limitations.