立体定向放射外科（SRS）单药治疗与全脑放疗联合SRS治疗非小细胞肺癌脑转移1至4个病灶患者的疗效比较：一项根据分级预后评估分层的随机对照试验的荟萃分析（PRISMA）
Stereotactic radiosurgery (SRS) alone versus whole brain radiotherapy plus SRS in patients with 1 to 4 brain metastases from non-small cell lung cancer stratified by the graded prognostic assessment: A meta-analysis (PRISMA) of randomized control trials.
作者信息
Qie Shuai, Li Yanhong, Shi Hong-Yun, Yuan Lanhui, Su Lei, Zhang Xi
机构信息
Department of Radiation Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei, P.R. China.
出版信息
Medicine (Baltimore). 2018 Aug;97(33):e11777. doi: 10.1097/MD.0000000000011777.
BACKGROUND
The present study aims to assess the therapeutic effect of whole brain radiotherapy (WBRT) for brain metastases from non-small cell lung cancer stratified by graded prognostic assessment (GPA) through meta-analysis.
METHODS
The Cochrane Library, PubMed, Ovid (Elsevier) were retrieved. The included randomized controlled trials (RCT) were evaluated, and the statistical analysis was performed using RevMan 5.3 software. Cochrane handbook was applied to evaluate the methodological quality. Statistical significance was considered as P < .05.
RESULTS
There were 2 randomized control trials identified eligible for the meta-analysis. Stereotactic radiosurgery (SRS)+WBRT did not significantly improved overall survival (OS) in 2 subgroups. (GPA <2: HR, 0.93; 95% confidence interval [CI], 0.61-1.40; P = .71), (GPA ≥2: HR, 1.28; 95% CI, 0.58-2.80; P = .54). The use of SRS+WBRT significantly extended brain tumor recurrence (BTR) free time in both subgroups (GPA <2: HR, 5.46; 95% CI: 2.09-14.22; P = .0005), (GPA ≥2: HR, 4.24; 95% CI: 2.24-8.04; P < .00001). The meta-analysis showed salvage therapy was more frequent among the SRS-alone in 2 subgroups (GPA <2: RR, 5.83; 95% CI: 1.47-23.06; P = .01), (GPA ≥2: RR, 2.53; 95% CI: 1.30-4.93; P = .006). The rate of grade 3 or 4 late radiation toxic effects was similar in 2 subgroups between SRS and SRS+WBRT CONCLUSIONS:: Because there are few studies to meet inclusion criteria, we cannot include more researches. The results of this analysis must be carefully interpreted in view of the unclear risk of bias in inclusion in the study. This meta-analysis of 2 randomized trails indicated that the combined treatment group did not show a survival benefit over SRS alone. However, SRS+WBRT improved BTR free time in the subgroup both GPA <2 and GPA ≥2 with the similar grade 3 or 4 late radiation toxicities.
背景
本研究旨在通过荟萃分析评估按分级预后评估（GPA）分层的全脑放疗（WBRT）对非小细胞肺癌脑转移的治疗效果。
方法
检索了Cochrane图书馆、PubMed、Ovid（爱思唯尔）。对纳入的随机对照试验（RCT）进行评估，并使用RevMan 5.3软件进行统计分析。应用Cochrane手册评估方法学质量。统计学显著性以P<0.05为标准。
结果
有2项随机对照试验被确定符合荟萃分析的条件。立体定向放射外科（SRS）+WBRT在2个亚组中未显著改善总生存期（OS）。（GPA<2：风险比[HR]，0.93；95%置信区间[CI]，0.61-1.40；P=0.71），（GPA≥2：HR，1.28；95%CI，0.58-2.80；P=0.54）。SRS+WBRT的使用在两个亚组中均显著延长了无脑肿瘤复发（BTR）时间（GPA<2：HR，5.46；95%CI：2.09-14.22；P=0.0005），（GPA≥2：HR，4.24；95%CI：2.24-8.04；P<0.00001）。荟萃分析显示，在2个亚组中，单纯SRS组的挽救治疗更频繁（GPA<2：相对危险度[RR]，5.83；95%CI：1.47-23.06；P=0.01），（GPA≥2：RR，2.53；95%CI：1.30-4.93；P=0.006）。SRS组和SRS+WBRT组在2个亚组中3级或4级晚期放射毒性发生率相似。结论：由于符合纳入标准的研究较少，我们无法纳入更多研究。鉴于纳入研究的偏倚风险不明确，本分析结果必须谨慎解读。这项对2项随机试验的荟萃分析表明，联合治疗组与单纯SRS相比未显示出生存获益。然而，SRS+WBRT在GPA<2和GPA≥2的亚组中均改善了无BTR时间，且3级或4级晚期放射毒性相似。
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