对先前接受过立体定向放射外科治疗的局部复发性脑转移瘤进行重复立体定向放射外科治疗：疗效和安全性的系统评价与荟萃分析
Repeat stereotactic radiosurgery for locally recurrent brain metastases previously treated with stereotactic radiosurgery: A systematic review and meta-analysis of efficacy and safety.
作者信息
Singh Raj, Didwania Prabhanjan, Lehrer Eric J, Palmer Joshua D, Trifiletti Daniel M, Sheehan Jason P
机构信息
Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA, USA.
Rady School of Management, University of California at San Diego, San Diego, CA, USA.
出版信息
J Radiosurg SBRT. 2022;8(1):1-10.
OBJECTIVES
To perform a systematic review and meta-analysis of outcomes for patients with locally recurrent brain metastases treated with a repeat course of stereotactic radiosurgery (rSRS).
METHOD
Primary outcomes were 1-year local control(LC) and radionecrosis (RN). Secondary outcomes were 1-year overall survival (OS) and 1-year distant brain control (DBC). Weighted random effects meta-analyses utilizing the DerSimonian and Laird methods were conducted to characterize summary effect sizes. Mixed effects regression models were utilized to analyze potential correlations between prognostic factors and outcomes.
RESULTS
In total, 347 patients with 462 brain metastases treated with rSRS were included. Estimated 1-year LC, OS, and DBC rates were 69.0% (95% CI: 61.0-77.0%), 49.7% (95% CI: 28.9-70.6%), and 41.6% (95% CI: 33.0-50.4%), respectively. The estimated RN rate was 16.1% (95% CI: 6.3-25.9%). Every 1 Gy increase in prescription dose was estimated to result in roughly 5% increase in 1-year LC (p = 0.14).
CONCLUSIONS
rSRS was well-tolerated with reasonable 1-year LC and OS. Dose escalation may result in improved LC.
目的
对接受重复立体定向放射外科治疗（rSRS）的局部复发性脑转移瘤患者的治疗结果进行系统评价和荟萃分析。
方法
主要结局为1年局部控制率（LC）和放射性坏死（RN）。次要结局为1年总生存率（OS）和1年远处脑转移控制率（DBC）。采用DerSimonian和Laird方法进行加权随机效应荟萃分析，以描述汇总效应量。使用混合效应回归模型分析预后因素与结局之间的潜在相关性。
结果
共纳入347例接受rSRS治疗的462个脑转移瘤患者。估计1年LC、OS和DBC率分别为69.0%（95%CI：61.0 - 77.0%）、49.7%（95%CI：28.9 - 70.6%）和41.6%（95%CI：33.0 - 50.4%）。估计RN率为16.1%（95%CI：6.3 - 25.9%）。处方剂量每增加1 Gy，估计1年LC增加约5%（p = 0.14）。
结论
rSRS耐受性良好，1年LC和OS合理。剂量递增可能会改善LC。
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