de Franca Sabrina Araujo, Tavares Wagner Malago, Salinet Angela Salomao Macedo, Teixeira Manoel Jacobsen, Paiva Wellingson Silva
Department of Research, Instituto Paulista De Saude Para Alta Complexidade, Brazil.
Institute of Neurology, University of São Paulo, São Paulo, Brazil.
Surg Neurol Int. 2020 Oct 29;11:360. doi: 10.25259/SNI_152_2020. eCollection 2020.
Minimally invasive procedures are gaining widespread acceptance in difficult-to-access brain tumor treatment. Stereotactic radiosurgery (SRS) is the preferred choice, however, laser interstitial thermal therapy (LITT) has emerged as a tumor cytoreduction technique. The present meta-analysis compared current SRS therapy with LITT in brain tumors.
A search was performed in Lilacs, PubMed, and Cochrane database. Patient's demographics, tumor location, therapy used, Karnofsky performance status score before treatment, and patient's outcome (median overall survival, progression-free survival, and adverse events) data were extracted from studies. The risk of bias was assessed by Cochrane collaboration tool.
Twenty-five studies were included in this meta-analysis. LITT and SRS MOS in brain metastasis patients were 12.8 months' versus 9.8 months (ranges 9.3-16.3 and 8.3-9.8; = 0.02), respectively. In a combined comparison of adverse effects among LITT versus SRS in brain metastasis, we found 15% reduction in absolute risk difference (-0.16; 95% confidence interval < 0.0001).
We could not state that LITT treatment is an optimal alternative therapy for difficult-to-access brain tumors due to the lack of systematic data that were reported in our pooled studies. However, our results identified a positive effect in lowering the absolute risk of adverse events compared with SRS therapy. Therefore, randomized trials are encouraged to ascertain LITT role, as upfront or postoperative/post-SRS therapy for brain tumor treatment.
微创手术在难以触及的脑肿瘤治疗中越来越被广泛接受。立体定向放射外科（SRS）是首选方法，然而，激光间质热疗（LITT）已成为一种肿瘤减灭技术。本荟萃分析比较了目前SRS治疗与LITT治疗脑肿瘤的效果。
在Lilacs、PubMed和Cochrane数据库中进行检索。从研究中提取患者的人口统计学数据、肿瘤位置、使用的治疗方法、治疗前的卡诺夫斯基功能状态评分以及患者的结局（中位总生存期、无进展生存期和不良事件）数据。采用Cochrane协作工具评估偏倚风险。
本荟萃分析纳入了25项研究。脑转移瘤患者中LITT和SRS的中位总生存期分别为12.8个月和9.8个月（范围分别为9.3 - 16.3个月和8.3 - 9.8个月；P = 0.02）。在脑转移瘤患者中LITT与SRS不良反应的综合比较中，我们发现绝对风险差异降低了15%（-0.16；95%置信区间<0.0001）。
由于我们汇总研究中缺乏系统报告的数据，我们不能称LITT治疗是难以触及的脑肿瘤的最佳替代疗法。然而，我们的结果表明，与SRS治疗相比，LITT在降低不良事件的绝对风险方面有积极作用。因此，鼓励进行随机试验以确定LITT作为脑肿瘤治疗的一线或术后/SRS后治疗的作用。
