London Gamma Knife Centre, Platinum Medical Centre, Wellington Hospital, Lodge Road, London, UK.
Computational Oncology Group, Department of Surgery and Cancer, Imperial College London, London, UK.
BMC Cancer. 2023 Oct 19;23(1):1004. doi: 10.1186/s12885-023-11452-7.
Brain metastases are the most common intracranial tumours. Variation exists in the use of stereotactic radiosurgery for patients with 10 or more brain metastases. Concerns include an increasing number of brain metastases being associated with poor survival, the lack of prospective, randomised data and an increased risk of toxicity.
We performed a systematic review and meta-analysis to assess overall survival of patients with ten or more brain metastases treated with stereotactic radiosurgery as primary therapy. The search strings were applied to MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Log hazard ratios and standard errors were estimated from each included study. A random-effects meta-analysis using the DerSimonian and Laird method was applied using the derived log hazard ratios and standard errors on studies which included a control group.
15 studies were included for systematic review. 12 studies were used for pooled analysis for overall survival at set time points, with a predicted 12 month survival of 20-40%. The random-effects meta-analysis in five studies of overall survival comparing ten or greater metastases against control showed statistically worse overall survival in the 10 + metastases group (1.10, 95% confidence interval 1.03-1.18, p-value = < 0.01, I = 6%). A funnel plot showed no evidence of bias. There was insufficient information for a meta-analysis of toxicity.
Overall survival outcomes of patients with ten or more brain metastases treated with SRS is acceptable and should not be a deterrent for its use. There is a lack of prospective data and insufficient real-world data to draw conclusions on toxicity.
CRD42021246115.
脑转移瘤是最常见的颅内肿瘤。对于 10 个或更多脑转移瘤患者，立体定向放射外科的应用存在差异。关注的问题包括越来越多的脑转移瘤与生存不良相关，缺乏前瞻性、随机数据以及毒性风险增加。
我们进行了系统评价和荟萃分析，以评估 10 个或更多脑转移瘤患者接受立体定向放射外科作为主要治疗的总生存率。搜索词应用于 MEDLINE、Embase 和 Cochrane 对照试验中心注册库（CENTRAL）。从每个纳入的研究中估计对数风险比和标准误差。使用 DerSimonian 和 Laird 方法的随机效应荟萃分析应用于包括对照组的研究中的推导对数风险比和标准误差。
纳入系统评价的 15 项研究。12 项研究用于总体生存率的汇总分析，在设定的时间点预测 12 个月生存率为 20-40%。在五项关于比较 10 个或更多转移瘤与对照组的总生存率的研究中进行的随机效应荟萃分析显示，在 10+转移瘤组中总生存率更差（1.10，95%置信区间 1.03-1.18，p 值<0.01，I=6%）。漏斗图显示无偏倚证据。对于毒性的荟萃分析没有足够的信息。
接受 SRS 治疗的 10 个或更多脑转移瘤患者的总体生存率结果是可以接受的，不应成为其使用的障碍。缺乏前瞻性数据和足够的真实世界数据来得出关于毒性的结论。
CRD42021246115。
