Khan Muhammad, Lin Jie, Liao Guixiang, Tian Yunhong, Liang Yingying, Li Rong, Liu Mengzhong, Yuan Yawei
Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Oncol. 2019 Mar 29;9:205. doi: 10.3389/fonc.2019.00205. eCollection 2019.
Significantly better local control is achieved with combination of whole brain radiotherapy and stereotactic radiosurgery in the treatment of multiple brain metastases. However, no survival benefit was reported from this advantage in local control. The objective of this study was to review the available evidence whether better local control achieved with whole brain radiotherapy plus stereotactic radiosurgery leads to any benefit in survival in patients with favorable prognostic factors. Electronic databases (PubMed, MEDLINE, and Cochrane Library) were searched until Oct 2018 to identify studies published in English that compared efficacy of whole brain radiotherapy plus stereotactic radiosurgery vs. whole brain radiotherapy alone or stereotactic radiosurgery alone in patients with brain metastases stratified on prognostic indices (Recursive Partitioning Analysis and Diagnosis-Specific Graded Prognostic Assessment). Primary outcome was survival. Five studies ( = 2728) were identified, 3 secondary analyses of the previously published RCTs and 2 retrospective studies, meeting the inclusion criteria. whole brain radiotherapy plus stereotactic radiosurgery showed improved survival in brain metastatic cancer patients with better prognostic factors particularly when compared to whole brain radiotherapy only. Its survival advantage over stereotactic radiosurgery only was limited to non-small cell lung cancer primary tumor histology. Whole brain radiotherapy in combination with stereotactic radiosurgery may improve survival and could be recommended selectively in patients with favorable prognostic factors particularly in comparison to whole brain radiotherapy only.
在治疗多发性脑转移瘤时，全脑放疗与立体定向放射外科联合应用可显著提高局部控制率。然而，这种局部控制方面的优势并未带来生存获益。本研究的目的是回顾现有证据，探讨全脑放疗联合立体定向放射外科实现的更好局部控制是否能使具有良好预后因素的患者在生存方面获益。检索电子数据库（PubMed、MEDLINE和Cochrane图书馆）直至2018年10月，以识别用英文发表的研究，这些研究比较了全脑放疗联合立体定向放射外科与单纯全脑放疗或单纯立体定向放射外科在根据预后指标（递归分区分析和特定诊断分级预后评估）分层的脑转移瘤患者中的疗效。主要结局是生存。共识别出5项研究（n = 2728），3项对先前发表的随机对照试验的二次分析和2项回顾性研究，符合纳入标准。全脑放疗联合立体定向放射外科在具有更好预后因素的脑转移癌患者中显示出生存改善，特别是与单纯全脑放疗相比时。其相对于单纯立体定向放射外科的生存优势仅限于非小细胞肺癌原发肿瘤组织学类型。全脑放疗联合立体定向放射外科可能改善生存，对于具有良好预后因素的患者可选择性推荐，特别是与单纯全脑放疗相比时。
