The Vivian L. Smith Department of Neurosurgery and Center for Precision Health, The University of Texas Health Science Center at Houston McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA.
Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de Mexico, México.
J Neurooncol. 2024 Oct;170(1):53-66. doi: 10.1007/s11060-024-04738-8. Epub 2024 Aug 17.
Stereotactic Radiosurgery (SRS) is the primary treatment for patients with limited numbers of small brain metastases. Head fixation is usually performed with framed-based (FB) fixation; however, mask-based (MB) fixation has emerged as a less invasive alternative. A comparative meta-analysis between both approaches has not been performed.
Databases were searched until August 28th, 2023, to identify studies comparing MB and FB SRS in the treatment of brain metastases. Our outcomes of interest included local tumor control (LTC), radiation necrosis (RN), mortality, and treatment time (TT). Mean difference (MD), risk ratio (RR), and hazard ratio (HR) were used for statistical comparisons.
From 295 articles initially identified, six studies (1 clinical trial) involving 509 patients were included. LTC revealed comparable RR at 6-months (RR = 0.95[95%CI = 0.89-1.01], p = 0.12) and a marginal benefit in FB SRS at 1-year (RR = 0.87[95%CI = 0.78-0.96], p = 0.005). However, in oligometastases exclusively treated with single-fraction SRS, LTC was similar among groups (RR = 0.92 [95%CI = 0.89-1.0], p = 0.30). Similarly, in patients with oligometastases treated with single-fraction SRS, RN (HR = 1.69; 95%CI = 0.72-3.97, p = 0.22), TT (MD = -29.64; 95%CI = -80.38-21.10, p = 0.25), and mortality were similar among groups (RR = 0.62; 95%CI = 0.22-1.76, p = 0.37).
Our findings suggest that FB and MB SRS, particularly oligometastases treated with single-fraction, are comparable in terms of LTC, RN, TT, and mortality. Further research is essential to draw definitive conclusions.
立体定向放射外科（SRS）是治疗数量有限的小脑转移瘤患者的主要方法。头部固定通常采用基于框架的（FB）固定；然而，基于面罩的（MB）固定已成为一种侵入性较小的替代方法。目前尚未对这两种方法进行比较性荟萃分析。
我们检索了数据库，直到 2023 年 8 月 28 日，以确定比较 MB 和 FB SRS 治疗脑转移瘤的研究。我们感兴趣的结局包括局部肿瘤控制（LTC）、放射性坏死（RN）、死亡率和治疗时间（TT）。使用均数差（MD）、风险比（RR）和危险比（HR）进行统计学比较。
最初从 295 篇文章中筛选出 6 项研究（1 项临床试验），共纳入 509 例患者。6 个月时的 LTC 显示出相似的 RR（RR=0.95[95%CI=0.89-1.01]，p=0.12），FB SRS 在 1 年时具有边缘获益（RR=0.87[95%CI=0.78-0.96]，p=0.005）。然而，在仅接受单次分割 SRS 治疗的寡转移瘤患者中，各组间的 LTC 相似（RR=0.92[95%CI=0.89-1.0]，p=0.30）。同样，在接受单次分割 SRS 治疗的寡转移瘤患者中，RN（HR=1.69；95%CI=0.72-3.97，p=0.22）、TT（MD=-29.64；95%CI=-80.38-21.10，p=0.25）和死亡率相似（RR=0.62；95%CI=0.22-1.76，p=0.37）。
我们的研究结果表明，FB 和 MB SRS，特别是接受单次分割治疗的寡转移瘤，在 LTC、RN、TT 和死亡率方面具有可比性。需要进一步的研究来得出明确的结论。
