Department of Neurological Surgery, Weill Cornell Medical College-New York Presbyterian Hospital, 525 E. 68th Street, P.O. Box 99, New York, NY 10065, USA.
J Neurooncol. 2011 May;103(1):1-17. doi: 10.1007/s11060-010-0360-0. Epub 2010 Dec 9.
Stereotactic radiosurgery (SRS) represents an important tool in neurosurgery and radiotherapy for addressing a multitude of diseases, most notably in the field of neuro-oncology. The pathologies for which it is employed vary significantly, and few controlled studies exist to evaluate its efficacy. We aimed to provide a quantitative meta-analysis of SRS applications in neuro-oncology, providing benchmarks for expected outcomes. The meta-analysis was conducted in accordance with established standards for evaluating observational data. Specific inclusion criteria were utilized, search terms recorded, and data extracted to summarize demographic and outcome statistics. Meta-analysis was conducted where statistically appropriate, and clinical outcomes summarized as tumor stability, survival, and complications in a pathology-specific manner. For vestibular schwannoma, 37 studies with a total 3,677 patients were included. Overall disease stabilization rate after adjustment for significant publication bias was 91.1%. Non-cranial nerve complication rate after publication bias adjustment was 5.6%. Accounting for publication bias, rate of hearing preservation was with 59.3%. For 456 glioblastoma multiforme (GBM) patients in 11 studies receiving SRS, median survival from diagnosis was 13.5-26 months, while overall complication rate was 11.4%. For meningioma, 15 studies with a total 2,734 patients were included; 77.1% were classified as skull base. Overall disease stabilization rate was 89.0, while overall complication rate was 7.0%. For metastatic disease, 27 studies with a total of 2,679 patients were included. Overall median survival from time of SRS was 5-14 months, overall 1-year survival rates were 15-54.9%, while reported local disease control rates were 59.6-96.8%. Stereotactic radiosurgery is an increasingly important tool in the management of neuro-oncologic diseases. While there is a pathology-specific role for SRS, current data show excellent results in treating several pathologies. As such, SRS adds significantly to the neurosurgical armamentarium for treating neuro-oncologic processes.
立体定向放射外科 (SRS) 是神经外科和放射治疗的重要工具，用于治疗多种疾病，尤其是神经肿瘤学领域。其应用的疾病种类差异很大，且很少有对照研究来评估其疗效。我们旨在对神经肿瘤学中的 SRS 应用进行定量荟萃分析，为预期结果提供基准。荟萃分析符合评估观察数据的既定标准。使用了具体的纳入标准，记录了搜索词，并提取数据以总结人口统计学和结果统计数据。在统计上适当的情况下进行荟萃分析，并按病理学特异性总结肿瘤稳定性、生存和并发症等临床结果。对于前庭神经鞘瘤，纳入了 37 项研究，共 3677 例患者。调整显著发表偏倚后，整体疾病稳定率为 91.1%。调整发表偏倚后，非颅神经并发症率为 5.6%。考虑到发表偏倚，听力保留率为 59.3%。在 11 项研究中，有 456 例胶质母细胞瘤多形性（GBM）患者接受了 SRS 治疗，从诊断到中位生存期为 13.5-26 个月，总并发症率为 11.4%。对于脑膜瘤，纳入了 15 项研究，共 2734 例患者；77.1%为颅底。整体疾病稳定率为 89.0%，总并发症率为 7.0%。对于转移性疾病，纳入了 27 项研究，共 2679 例患者。从 SRS 时间到中位生存期为 5-14 个月，总 1 年生存率为 15-54.9%，而报告的局部疾病控制率为 59.6-96.8%。立体定向放射外科是神经肿瘤学疾病管理中越来越重要的工具。虽然 SRS 在特定病理中有作用，但目前的数据显示其在治疗几种病理方面的效果非常出色。因此，SRS 为治疗神经肿瘤过程增加了重要的神经外科手段。
