立体定向再放疗治疗既往放射外科治疗后脑转移局部失败：系统评价和荟萃分析。
Stereotactic reirradiation for local failure of brain metastases following previous radiosurgery: Systematic review and meta-analysis.
机构信息
Radiotherapy Department, University of Florence, Florence, Italy.
Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
出版信息
Crit Rev Oncol Hematol. 2020 Sep;153:103043. doi: 10.1016/j.critrevonc.2020.103043. Epub 2020 Jul 2.
INTRODUCTION
Local failure (LF) following stereotactic radiosurgery (SRS) of brain metastases (BM) may be treated with a second course of SRS (SRS2), though this procedure may increase the risk of symptomatic radionecrosis (RN).
METHODS
A literature search was conducted according to PRISMA to identify studies reporting LF, overall survival (OS) and RN rates following SRS2. Meta-analysis was performed to identify predictors of RN.
RESULTS
Analysis included 11 studies (335 patients,389 metastases). Pooled 1-year LF was 24 %(CI95 % 19-30 %): heterogeneity was acceptable (I2 = 21.4 %). Median pooled OS was 14 months (Confidence Interval 95 %, CI95 % 8.8-22.0 months). Cumulative crude RN rate was 13 % (95 %CI 8 %-19 %), with acceptable heterogeneity (I2 = 40.3 %). Subgroup analysis showed higher RN incidence in studies with median patient age ≥59 years (13 % [95 %CI 8 %-19 %] vs 7 %[95 %CI 3 %-12 %], p = 0.004) and lower incidence following prior Whole Brain Radiotherapy (WBRT, 19 %[95 %CI 13 %-25 %] vs 7%[95 %CI 3 %-13 %], p = 0.004).
CONCLUSIONS
SRS2 is an effective strategy for in-site recurrence of BM previously treated with SRS.
介绍
立体定向放射外科（SRS）治疗脑转移瘤（BM）后的局部失败（LF）可采用第二疗程 SRS（SRS2）治疗，尽管这可能会增加症状性放射性坏死（RN）的风险。
方法
按照 PRISMA 进行文献检索，以确定报告 SRS2 后 LF、总生存（OS）和 RN 发生率的研究。进行荟萃分析以确定 RN 的预测因素。
结果
分析纳入了 11 项研究（335 例患者，389 个转移灶）。汇总的 1 年 LF 为 24%（95%CI95% 19-30%）：异质性可接受（I2=21.4%）。中位汇总 OS 为 14 个月（95%置信区间，CI95% 8.8-22.0 个月）。累积粗 RN 发生率为 13%（95%CI 8%-19%），异质性可接受（I2=40.3%）。亚组分析显示，患者中位年龄≥59 岁的研究中 RN 发生率较高（13%[95%CI 8%-19%]比 7%[95%CI 3%-12%]，p=0.004），而 WBRT 后发生率较低（19%[95%CI 13%-25%]比 7%[95%CI 3%-13%]，p=0.004）。
结论
SRS2 是治疗 SRS 治疗后 BM 局部复发的有效策略。
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