Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Naval Pohang Hospital, Pohang, Republic of Korea.
Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Eur J Radiol. 2020 Jun;127:108978. doi: 10.1016/j.ejrad.2020.108978. Epub 2020 Apr 7.
To perform a systematic review and meta-analysis evaluating usefulness of high-risk CT features (HRFs) on follow-up CT in detecting local recurrence after stereotactic body radiation therapy (SBRT) in lung cancer patients.
Pubmed and EMBASE were searched up to January 11th, 2019. We included studies that differentiated local recurrence from post-SBRT changes after SBRT on follow-up CT in lung cancer patients. Methodological quality was assessed using QUADAS-2. The association between HRFs and local recurrence were pooled in the form of odds ratio (OR) using the random effects model. Heterogeneity was examined by the Inconsistency index (I).
Eight studies were included, consisting of 356 lung cancer patients. The overall prevalence of patients with local recurrence was 18.8 % (67/356). Compared with post-SBRT changes, local recurrence after SBRT more frequently demonstrated air-bronchogram disappearance (OR = 7.15), bulging margin (OR = 24.12), craniocaudal growth (OR = 26.07), enlargement after 12 months (OR = 28.11), enlarging opacity (OR = 7.92), linear margin disappearance (OR = 29.24), and sequential enlargement (OR = 83.23) (p ≤ 0.02). Pleural effusion appearance was not related with local recurrence (p = 0.82). Heterogeneity varied among HRFs (I = 0-91 %). The quality of the studies was considered moderate.
Several HRFs on follow-up CT after SBRT were useful in suggesting local recurrence. These HRFs may help raise clinical suspicion of local recurrence, initiate prompt additional test for confirmation and perform subsequent proper personalized salvage treatment.
系统评价和荟萃分析评估高风险 CT 特征（HRFs）在肺癌患者立体定向体部放射治疗（SBRT）后随访 CT 中检测局部复发的有用性。
检索 Pubmed 和 EMBASE，截至 2019 年 1 月 11 日。我们纳入了在肺癌患者 SBRT 后随访 CT 上区分局部复发和 SBRT 后改变的研究。使用 QUADAS-2 评估方法学质量。使用随机效应模型，以优势比（OR）的形式汇总 HRFs 与局部复发之间的关联。通过不一致指数（I）检查异质性。
纳入了 8 项研究，共 356 例肺癌患者。局部复发患者的总体患病率为 18.8%（67/356）。与 SBRT 后改变相比，SBRT 后局部复发更常表现为空气支气管征消失（OR=7.15）、膨隆边缘（OR=24.12）、颅尾生长（OR=26.07）、12 个月后增大（OR=28.11）、增大的不透明度（OR=7.92）、线性边缘消失（OR=29.24）和连续增大（OR=83.23）（p≤0.02）。胸腔积液表现与局部复发无关（p=0.82）。HRFs 之间的异质性各不相同（I=0-91%）。研究质量被认为是中等的。
SBRT 后随访 CT 上的几个 HRFs 有助于提示局部复发。这些 HRFs 可能有助于提高对局部复发的临床怀疑，及时进行额外的检查以确认，并随后进行适当的个体化抢救治疗。
