De Maria Lucio, Terzi di Bergamo Lodovico, Conti Alfredo, Hayashi Kazuhiko, Pinzi Valentina, Murai Taro, Lanciano Rachelle, Burneikiene Sigita, Buglione di Monale Michela, Magrini Stefano Maria, Fontanella Marco Maria
Unit of Neurosurgery, University of Brescia and ASST Spedali Civili, Brescia, Italy.
Institute of Oncology Research, Bellinzona, Switzerland.
Front Oncol. 2021 Mar 29;11:652646. doi: 10.3389/fonc.2021.652646. eCollection 2021.
Possible treatment strategies for recurrent malignant gliomas include surgery, chemotherapy, radiotherapy, and combined treatments. Among different reirradiation modalities, the CyberKnife System has shown promising results. We conducted a systematic review of the literature and a meta-analysis to establish the efficacy and safety of CyberKnife treatment for recurrent malignant gliomas.
We searched PubMed, MEDLINE, and EMBASE from 2000 to 2021 for studies evaluating the safety and efficacy of CyberKnife treatment for recurrent WHO grade III and grade IV gliomas of the brain. Two independent reviewers selected studies and abstracted data. Missing information was requested from the authors via email correspondence. The primary outcomes were median Overall Survival, median Time To Progression, and median Progression-Free Survival. We performed subgroup analyses regarding WHO grade and chemotherapy. Besides, we analyzed the relationship between median Time To Recurrence and median Overall Survival from CyberKnife treatment. The secondary outcomes were complications, local response, and recurrence. Data were analyzed using random-effects meta-analysis.
Thirteen studies reporting on 398 patients were included. Median Overall Survival from initial diagnosis and CyberKnife treatment was 22.6 months and 8.6 months. Median Time To Progression and median Progression-Free Survival from CyberKnife treatment were 6.7 months and 7.1 months. Median Overall Survival from CyberKnife treatment was 8.4 months for WHO grade IV gliomas, compared to 11 months for WHO grade III gliomas. Median Overall Survival from CyberKnife treatment was 4.4 months for patients who underwent CyberKnife treatment alone, compared to 9.5 months for patients who underwent CyberKnife treatment plus chemotherapy. We did not observe a correlation between median Time To Recurrence and median Overall Survival from CyberKnife. Rates of acute neurological and acute non-neurological side effects were 3.6% and 13%. Rates of corticosteroid dependency and radiation necrosis were 18.8% and 4.3%.
Reirradiation of recurrent malignant gliomas with the CyberKnife System provides encouraging survival rates. There is a better survival trend for WHO grade III gliomas and for patients who undergo combined treatment with CyberKnife plus chemotherapy. Rates of complications are low. Larger prospective studies are warranted to provide more accurate results.
复发性恶性胶质瘤的可能治疗策略包括手术、化疗、放疗及联合治疗。在不同的再程放疗方式中，射波刀系统已显示出有前景的结果。我们进行了一项文献系统综述和荟萃分析，以确定射波刀治疗复发性恶性胶质瘤的疗效和安全性。
我们检索了2000年至2021年期间的PubMed、MEDLINE和EMBASE数据库，以查找评估射波刀治疗复发性世界卫生组织（WHO）III级和IV级脑胶质瘤安全性和疗效的研究。两名独立的评审员筛选研究并提取数据。通过电子邮件与作者索要缺失信息。主要结局为中位总生存期、中位疾病进展时间和中位无进展生存期。我们对WHO分级和化疗进行了亚组分析。此外，我们分析了射波刀治疗后的中位复发时间与中位总生存期之间的关系。次要结局为并发症、局部反应和复发。采用随机效应荟萃分析对数据进行分析。
纳入了13项报告398例患者的研究。从初始诊断到射波刀治疗的中位总生存期为22.6个月，射波刀治疗后的中位总生存期为8.6个月。射波刀治疗后的中位疾病进展时间和中位无进展生存期分别为6.7个月和7.1个月。WHO IV级胶质瘤患者射波刀治疗后的中位总生存期为8.4个月，而WHO III级胶质瘤患者为11个月。单纯接受射波刀治疗的患者射波刀治疗后的中位总生存期为4.4个月，而接受射波刀治疗加化疗的患者为9.5个月。我们未观察到射波刀治疗后的中位复发时间与中位总生存期之间存在相关性。急性神经和急性非神经副作用的发生率分别为3.6%和13%。皮质类固醇依赖和放射性坏死的发生率分别为18.8%和4.3%。
使用射波刀系统对复发性恶性胶质瘤进行再程放疗可提供令人鼓舞的生存率。WHO III级胶质瘤患者以及接受射波刀加化疗联合治疗的患者有更好的生存趋势。并发症发生率较低。需要开展更大规模的前瞻性研究以提供更准确的结果。
