Pollock Bruce E
Departments of Neurological Surgery and Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minn., USA.
Prog Neurol Surg. 2006;19:152-170. doi: 10.1159/000095189.
Stereotactic radiosurgery has been increasingly utilized to manage a wide variety of indications including vascular malformations, benign and malignant tumors, and functional disorders.
Review of the recent literature on stereotactic radiosurgery by evidence-based standards.
The vast majority of published papers on stereotactic radiosurgery is of rather poor quality (level 3 or below). Two studies provide level 1 evidence showing an improvement in local tumor control or survival for patients with 1-3 brain metastases having radiosurgery in conjunction with whole brain radiation therapy when compared to patients having whole brain radiation therapy alone. One randomized trial found no improvement in facial pain outcomes for trigeminal neuralgia patients having a longer segment of the nerve irradiated.
For a variety of reasons it is unlikely that randomized clinical trials will be performed to evaluate the clinical usefulness of stereotactic radiosurgery. Nonetheless, the preponderance of level 3 information supports the role of radiosurgery as either an adjunct or alternative to surgical resection or fractionated radiation therapy.
立体定向放射外科已越来越多地用于处理各种病症，包括血管畸形、良性和恶性肿瘤以及功能性疾病。
按照循证医学标准回顾近期关于立体定向放射外科的文献。
绝大多数已发表的关于立体定向放射外科的论文质量相当差（3级或更低）。两项研究提供了1级证据，表明与仅接受全脑放射治疗的患者相比，接受放射外科联合全脑放射治疗的1 - 3个脑转移瘤患者的局部肿瘤控制或生存率有所改善。一项随机试验发现，接受较长节段神经照射的三叉神经痛患者的面部疼痛结局没有改善。
由于多种原因，不太可能进行随机临床试验来评估立体定向放射外科的临床效用。尽管如此，3级信息的优势支持放射外科作为手术切除或分割放射治疗的辅助手段或替代方法的作用。
