Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Pract Radiat Oncol. 2021 Sep-Oct;11(5):354-365. doi: 10.1016/j.prro.2021.04.002. Epub 2021 Jun 9.
This evidence report synthesizes the available evidence on radiation therapy for brain metastases.
The literature search included PubMed, EMBASE, Web of Science, Scopus, CINAHL, clinicaltrials.gov, and published guidelines in July 2020; independently submitted data, expert consultation, and contacting authors. Included studies were randomized controlled trials (RCTs) and large observational studies (for safety assessments), evaluating whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination, as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma.
Ninety-seven studies reported in 189 publications were identified, but the number of analyses was limited owing to different intervention and comparator combinations as well as insufficient reporting of outcome data. Risk of bias varied, and 25 trials were terminated early, predominantly owing to poor accrual. The combination of SRS plus WBRT compared with SRS alone or WBRT alone showed no statistically significant difference in overall survival (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.69%-1.73%; 4 RCTs) or death owing to brain metastases (relative risk [RR], 0.93; 95% CI, 0.48%-1.81%; 3 RCTs). Radiation therapy after surgery did not improve overall survival compared with surgery alone (HR, 0.98; 95% CI, 0.76%-1.26%; 5 RCTs). Data for quality of life, functional status, and cognitive effects were insufficient to determine effects of WBRT, SRS, or postsurgery interventions. We did not find systematic differences across interventions in serious adverse events, number of adverse events, radiation necrosis, fatigue, or seizures. WBRT plus systemic therapy (RR 1.44; 95% CI, 1.03%-2.00%; 14 studies) was associated with increased risks for vomiting compared with WBRT alone.
Despite the substantial research literature on radiation therapy, comparative effectiveness information is limited. There is a need for more data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.
本证据报告综合了现有关于脑转移瘤放射治疗的证据。
文献检索包括 2020 年 7 月的 PubMed、EMBASE、Web of Science、Scopus、CINAHL、clinicaltrials.gov 和已发布的指南；独立提交数据、专家咨询和联系作者。纳入的研究为随机对照试验（RCT）和大型观察性研究（用于安全性评估），评估了全脑放射治疗（WBRT）和立体定向放射外科（SRS）单独或联合应用，作为初始或术后治疗，以及有或没有系统治疗，适用于肺癌、乳腺癌或黑色素瘤所致脑转移的成人。
共确定了 189 篇出版物中报道的 97 项研究，但由于干预和对照组合不同，以及结局数据报告不充分，分析数量有限。偏倚风险存在差异，25 项试验提前终止，主要是由于入组人数不足。与 SRS 单药或 WBRT 单药相比，SRS 联合 WBRT 治疗在总生存方面无统计学意义差异（风险比 [HR]，1.09；95%置信区间 [CI]，0.69%-1.73%；4 项 RCT）或脑转移相关死亡（相对风险 [RR]，0.93；95% CI，0.48%-1.81%；3 项 RCT）。与单纯手术相比，手术后放疗并不能改善总生存（HR，0.98；95% CI，0.76%-1.26%；5 项 RCT）。WBRT、SRS 或手术后干预对生活质量、功能状态和认知影响的数据不足以确定其作用。我们没有发现各干预措施之间在严重不良事件、不良事件数量、放射性坏死、疲劳或癫痫发作方面存在系统性差异。与 WBRT 单药相比，WBRT 联合全身治疗（RR 1.44；95% CI，1.03%-2.00%；14 项研究）与呕吐风险增加相关。
尽管关于放射治疗的研究文献很多，但比较有效性信息有限。需要更多关于生活质量、功能状态和认知影响等患者相关结局的数据。
