Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Neurosurgery, National University Hospital, Singapore, Singapore.
Chin Clin Oncol. 2024 Apr;13(2):22. doi: 10.21037/cco-23-136. Epub 2024 Apr 17.
The role of adjuvant radiotherapy (RT) after gross total resection (GTR) of the World Health Organization (WHO) grade II ependymoma is controversial. Therefore, we aimed to compare the outcomes of adjuvant RT against observation after GTR of WHO grade II ependymoma. We also compared the outcomes of adjuvant RT against observation after subtotal resection (STR) of WHO grade II ependymoma and performed further subgroup analysis by age and tumor location.
PubMed and Embase were systematically reviewed for studies published up till 25 November 2022. Studies that reported individual-participant data on patients who underwent surgery followed by adjuvant RT/observation for WHO grade II ependymoma were included. The exposure was whether adjuvant RT was administered, and the outcomes were recurrence and overall survival (OS). Subgroup analyses were performed by the extent of resection (GTR or STR), tumor location (supratentorial or infratentorial), and age at the first surgery (<18 or ≥18 years old).
Of the 4,647 studies screened, three studies reporting a total of 37 patients were included in the analysis. Of these 37 patients, 67.6% (25 patients) underwent GTR, and 51.4% (19 patients) underwent adjuvant RT. Adjuvant RT after GTR was not significantly associated with both recurrence (odds ratio =5.50; 95% confidence interval: 0.64-60.80; P=0.12) and OS (P=0.16). Adjuvant RT was also not significantly associated with both recurrence and OS when the cohort was analyzed as a whole and on subgroup analysis by age and tumor location. However, adjuvant RT was associated with significantly longer OS after STR (P=0.03) with the median OS being 6.33 years, as compared to 0.40 years for patients who underwent STR followed by observation.
Based on our meta-analysis of 37 patients, administration of adjuvant RT after GTR was not significantly associated with improvement in OS or recurrence in patients with WHO grade II ependymoma. However, due to the small number of patients included in the analysis, further prospective controlled studies are warranted.
在世界卫生组织（WHO）二级室管膜瘤完全切除（GTR）后，辅助放疗（RT）的作用存在争议。因此，我们旨在比较 GTR 后辅助 RT 与观察的结果，以及在 WHO 二级室管膜瘤行次全切除（STR）后辅助 RT 与观察的结果。我们还按年龄和肿瘤位置进行了进一步的亚组分析。
系统检索了 PubMed 和 Embase 数据库，检索截至 2022 年 11 月 25 日发表的研究。纳入了报告接受手术治疗后行辅助 RT/观察的 WHO 二级室管膜瘤患者个体参与者数据的研究。暴露因素为是否行辅助 RT，结局为复发和总生存（OS）。亚组分析按切除程度（GTR 或 STR）、肿瘤位置（幕上或幕下）和首次手术时的年龄（<18 岁或≥18 岁）进行。
在筛选的 4647 篇研究中，有 3 项研究共纳入 37 例患者进行分析。在这 37 例患者中，67.6%（25 例）行 GTR，51.4%（19 例）行辅助 RT。GTR 后行辅助 RT 与复发（比值比=5.50；95%置信区间：0.64-60.80；P=0.12）和 OS（P=0.16）均无显著相关性。当分析整个队列和按年龄和肿瘤位置进行亚组分析时，辅助 RT 与复发和 OS 也无显著相关性。然而，STR 后行辅助 RT 与 OS 显著相关（P=0.03），中位 OS 为 6.33 年，而 STR 后行观察的患者中位 OS 为 0.40 年。
基于我们对 37 例患者的荟萃分析，GTR 后行辅助 RT 与 WHO 二级室管膜瘤患者的 OS 或复发改善无显著相关性。但是，由于分析中纳入的患者数量较少，需要进一步的前瞻性对照研究。
