大分割立体定向放射外科与单次分割立体定向放射外科治疗脑转移瘤的系统评价和Meta分析
Hypofractionated versus single-fraction stereotactic radiosurgery for the treatment of brain metastases: A systematic review and meta-analysis.
作者信息
July Julius, Pranata Raymond
机构信息
Department of Neurosurgery, Medical Faculty of Pelita Harapan University, Lippo Village Tangerang, Neuroscience Centre Siloam Hospital, Lippo Village, Tangerang, Indonesia.
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
出版信息
Clin Neurol Neurosurg. 2021 Jul;206:106645. doi: 10.1016/j.clineuro.2021.106645. Epub 2021 Apr 20.
OBJECTIVE
This systematic review and meta-analysis aimed to synthesize the latest evidence on the hypofractionated stereotactic radiosurgery (HF-SRS) compared to single-fraction stereotactic radiosurgery (SF-SRS) for the treatment of brain metastases.
METHODS
We systematically searched PubMed, Scopus, EuropePMC, ProQuest, and Cochrane Central Databases. Original research articles investigating patients with brain metastasis receiving HF-SRS or SF-SRS reporting the local control/failure and/or radionecrosis during follow-up were included.
RESULTS
There were 1100 patients from 7 studies. 616 lesions were allocated to HF-SRS group and 777 lesions were allocated to SF-SRS group. Pooled rate of local control was 88% (95% CI 84%, 91%) in HF-SRS group and 81% (95% CI 74%, 88%) in the SF-SRS groups. Local control was higher in patients receiving HF-SRS compared to SF-SRS (OR 1.53 [95% CI 1.08, 2.18], p = 0.018; I: 0%). Pooled rate of radionecrosis was 7% (95% CI 3%, 12%) in HF-SRS group and 15% (95% CI 8%, 23%) in the SF-SRS groups. Similar rate of radionecrosis was observed in both HF-SRS and SF-SRS (OR 0.82 [95% CI 0.31, 2.21], p = 0.698; I: 61.3%). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) qualification showed a low level of certainty for the higher local control in patients receiving HF-SRS compared to SF-SRS and a very low level of certainty for similar risk of radionecrosis between the two groups.
CONCLUSION
This meta-analysis showed that HF-SRS was associated with higher local control and similar rate of radionecrosis compared to SF-SRS in patients with brain metastases.
PROSPERO ID
CRD42020210469.
目的
本系统评价和荟萃分析旨在综合最新证据，比较超分割立体定向放射外科治疗（HF-SRS）与单次分割立体定向放射外科治疗（SF-SRS）在治疗脑转移瘤方面的效果。
方法
我们系统检索了PubMed、Scopus、EuropePMC、ProQuest和Cochrane中心数据库。纳入了调查接受HF-SRS或SF-SRS治疗的脑转移瘤患者的原始研究文章，这些文章报告了随访期间的局部控制/失败和/或放射性坏死情况。
结果
7项研究共纳入1100例患者。616个病灶被分配到HF-SRS组，777个病灶被分配到SF-SRS组。HF-SRS组的局部控制合并率为88%（95%CI 84%，91%），SF-SRS组为81%（95%CI 74%，88%）。接受HF-SRS治疗的患者局部控制率高于SF-SRS组（OR 1.53[95%CI 1.08，2.18]，p = 0.018；I² = ）。HF-SRS组的放射性坏死合并率为7%（95%CI 3%，12%），SF-SRS组为15%（95%CI 8%，23%）。HF-SRS和SF-SRS两组的放射性坏死率相似（OR 0.82[95%CI 0.31，2.21]，p = 0.698；I² = 61.3%）。推荐分级、评估、制定与评价（GRADE）质量评估显示，与SF-SRS相比，接受HF-SRS治疗的患者局部控制率更高的确定性较低，两组放射性坏死风险相似的确定性非常低。
结论
这项荟萃分析表明，在脑转移瘤患者中，与SF-SRS相比，HF-SRS与更高的局部控制率和相似的放射性坏死率相关。
国际前瞻性系统评价注册编号
CRD42020210469。
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