Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Student Research Committee, Qom University of Medical Sciences, Qom, Iran.
Neurosurg Rev. 2024 Aug 13;47(1):423. doi: 10.1007/s10143-024-02666-9.
Stereotactic Radiosurgery (SRS) delivers a high dose of radiation to a specific brain area while limiting radiation to nearby healthy tissue. While most SRS has traditionally been performed with a stereotactic frame-based approach, this study aims to investigate the safety and efficacy of frameless radiosurgery in patients with brain metastases. Our study followed the recommended guidelines summarized in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The electronic databases of PubMed/Medline, Scopus, Embase, and Web of Science (WOS) were searched from inception to 10 October 2023. The pooled rate of outcomes was calculated using random effect model and Restricted maximum-likelihood (REML) method. All statistical analysis was performed by STATA V.17. A total of 499 studies were recruited from the electronic databases. After removing duplicates (n = 117), 382 studies were used for title/abstract, and 329 were removed from the study selection process. A total of 53 articles were used for full-text assessment, and 35 studies were included for data extraction. Our analysis revealed a significant increase across all pooled survival rates and local control rates by initiating the radiosurgery for patients, estimating the pooled 6-month OSR of 75% (95% CI: 68-81%), 1-year overall survival rate (OSR) of 60% (95% CI: 51-69%), 18-month OSR of 48% (95% CI: 10-85%), 2-year OSR of 39% (95% CI: 19-58%), 1-year progression-free survival rate (PFSR) of 68% (95% CI: 39-98%), 2-year PFSR of 75% (95% CI: 58-91%), 6-month local control rate (LCR) of 93% (95% CI: 90-96%), and 12-month LCR of 86% (95% CI: 82-90%). Our meta-analysis findings confirm the efficacy of frameless radiosurgery in treating brain metastases. Using data from several trials, we were able to demonstrate stereotactic radiosurgery's effectiveness as a therapy option for brain metastasis patients, demonstrating local control and reasonable overall survival.
立体定向放射外科 (SRS) 向特定的脑区提供高剂量的辐射，同时将辐射限制在附近的健康组织。虽然传统上大多数 SRS 都是通过立体定向框架方法进行的，但本研究旨在调查无框架放射外科治疗脑转移患者的安全性和疗效。我们的研究遵循了系统评价和荟萃分析 (PRISMA) 推荐的指南清单。从成立到 2023 年 10 月 10 日，我们在 PubMed/Medline、Scopus、Embase 和 Web of Science (WOS) 的电子数据库中进行了搜索。使用随机效应模型和最大似然 (REML) 方法计算结果的汇总率。所有统计分析均由 STATA V.17 进行。从电子数据库中共招募了 499 项研究。去除重复项 (n=117) 后，382 项研究用于标题/摘要，329 项研究在研究选择过程中被排除。共有 53 篇文章用于全文评估，35 项研究用于数据提取。我们的分析显示，所有汇总生存率和局部控制率都随着患者接受放射外科治疗而显著提高，估计 6 个月的 OS 率为 75% (95% CI：68-81%)，1 年总生存率为 60% (95% CI：51-69%)，18 个月的 OS 率为 48% (95% CI：10-85%)，2 年的 OS 率为 39% (95% CI：19-58%)，1 年无进展生存率为 68% (95% CI：39-98%)，2 年无进展生存率为 75% (95% CI：58-91%)，6 个月的局部控制率为 93% (95% CI：90-96%)，12 个月的局部控制率为 86% (95% CI：82-90%)。我们的荟萃分析结果证实了无框架放射外科治疗脑转移的疗效。使用来自几项试验的数据，我们能够证明立体定向放射外科作为脑转移患者治疗选择的有效性，显示出局部控制和合理的总体生存率。
