大体积（>2cm）脑转移瘤的单次和低分割立体定向放射外科治疗：系统评价。
Single- and hypofractionated stereotactic radiosurgery for large (> 2 cm) brain metastases: a systematic review.
机构信息
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Neurosurgery, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
出版信息
J Neurooncol. 2021 Aug;154(1):25-34. doi: 10.1007/s11060-021-03805-8. Epub 2021 Jul 15.
PURPOSE
Since frameless stereotactic radiosurgery (SRS) techniques have been recently introduced, hypofractionated SRS (HF-SRS) for large brain metastases (BMs) is gradually increasing. To verify the efficacy and safety of HF-SRS for large BMs, we aimed to perform a systematic review and compared them with SF-SRS.
METHODS
We systematically searched the studies regarding SF-SRS or HF-SRS for large (> 2 cm) BM from databases including PubMed, Embase, and the Cochrane Library on July 31, 2018. Biologically effective dose with the α/β ratio of 10 (BED), 1-year local control (LC), and radiation necrosis (RN) were compared between the two groups, with the studies being weighted by the sample size.
RESULTS
The 15 studies with 1049 BMs that described 1-year LC and RN were included. HF-SRS tended to be performed in larger tumors; however, higher mean BED (50.1 Gy versus 40.4 Gy, p < 0.0001) was delivered in the HF-SRS group, which led to significantly improved 1-year LC (81.6 versus 69.0%, p < 0.0001) and 1-year overall survival (55.1 versus 47.2%, p < 0.0001) in the HF-SRS group compared to the SF-SRS group. In contrast, the incidence of radiation toxicity was significantly decreased in the HF-SRS group compared to the SF-SRS group (8.0 versus 15.6%, p < 0.0001).
CONCLUSION
HF-SRS results in better LC of large BMs while simultaneously reducing RN compared to SF-SRS. Thus, HF-SRS should be considered a priority for SF-SRS in patients with large BMs who are not suitable to undergo surgical resection.
目的
由于无框架立体定向放射外科（SRS）技术最近已被引入，因此对于大的脑转移瘤（BM），逐渐增加了分次 SRS（HF-SRS）。为了验证 HF-SRS 治疗大 BM 的疗效和安全性，我们旨在进行系统评价，并将其与 SF-SRS 进行比较。
方法
我们系统地从包括 PubMed、Embase 和 Cochrane Library 在内的数据库中搜索了关于 SF-SRS 或 HF-SRS 治疗大（>2cm）BM 的研究，截止日期为 2018 年 7 月 31 日。使用生物学有效剂量（BED）与 α/β 比值为 10（BED）、1 年局部控制（LC）和放射性坏死（RN）来比较两组之间的差异，两组的研究均根据样本量加权。
结果
纳入了 15 项研究，共 1049 个 BM，描述了 1 年的 LC 和 RN。HF-SRS 倾向于治疗更大的肿瘤；然而，HF-SRS 组给予了更高的平均 BED（50.1Gy 比 40.4Gy，p<0.0001），导致 HF-SRS 组 1 年 LC（81.6%比 69.0%，p<0.0001）和 1 年总生存率（55.1%比 47.2%，p<0.0001）明显提高。相比之下，HF-SRS 组的放射性毒性发生率明显低于 SF-SRS 组（8.0%比 15.6%，p<0.0001）。
结论
与 SF-SRS 相比，HF-SRS 治疗大 BM 时可获得更好的 LC，同时降低 RN。因此，对于不适合手术切除的大 BM 患者，HF-SRS 应优先考虑作为 SF-SRS 的替代方案。
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