前庭神经鞘瘤患者的重复立体定向放射外科治疗：一项系统评价和荟萃分析。

Repeat stereotactic radiosurgery in vestibular schwannoma patients: A systematic review and meta-analysis.

作者信息

Hajikarimloo Bardia, Habibi Mohammad Amin, Sabbagh Alvani Mohammadamin, Zare Amir Hessam, Tos Salem M, Sheehan Jason P

机构信息

Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.

Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

J Clin Neurosci. 2024 Dec;130:110905. doi: 10.1016/j.jocn.2024.110905. Epub 2024 Nov 5.

DOI:10.1016/j.jocn.2024.110905

PMID:39504737

Abstract

BACKGROUND

Regarding the newly diagnosed vestibular schwannomas (VSs), active surveillance, microsurgical resection (MS), and stereotactic radiosurgery (SRS) are the leading treatment options. Although SRS is an effective intervention with a low incidence of complications, failure may occur occasionally. Several options, including repeat SRS, are considered salvage treatment after failure of the SRS. In this systematic review and meta-analysis study, we aimed to evaluate the efficacy and outcomes of repeat stereotactic radiosurgery (SRS) in progressive VS following the failure of the initial SRS.

METHOD

The electronic databases of PubMed/Medline, Scopus, Embase, and Web of Science (WOS) were searched from inception to August 23rd, 2024. Studies that evaluated the role of repeat SRS in the setting of VS were included. The risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions tool. The R program performed the meta-analyses, sensitivity analysis, publication bias, and meta-regression.

RESULTS

A total of 11 studies encompassing 260 VS patients with repeat SRS were included in our study. The median time interval between initial and repeat SRSs ranged from tumor volume ranged from 43 to 62 months. Our analysis revealed a pooled tumor control of 91 % (95 % CI: 86 %-94 %). Regarding the radiological response, the pooled regression rate was 59 % (95 % CI: 52 %- 65 %), while the pooled progression rate was 9 % (95 % CI: 6 %- 14 %). Regarding the clinical outcomes, the pooled serviceable hearing preservation (SHP) rate was 36 % (95 % CI: 22 %-53 %), while worsened fifth cranial nerve (CN) and seventh CN rates were 12 % (95 % CI: 7 %- 19 %) and 8 % (95 % CI: 5 %- 12 %), respectively. In addition, the pooled adverse radiation effect (ARE) rate was 6 % (95 % CI: 3 %- 11 %).

CONCLUSION

Our results suggest that the repeat SRS following the failure of the initial SRS in VS is associated with favorable outcomes, including tumor control, SHP, and CN worsening concurrent with low ARE rates.

摘要

背景

对于新诊断的前庭神经鞘瘤（VS），主动监测、显微手术切除（MS）和立体定向放射外科治疗（SRS）是主要的治疗选择。尽管SRS是一种有效的干预措施，并发症发生率较低，但偶尔也可能失败。包括重复SRS在内的几种选择被认为是SRS失败后的挽救治疗。在这项系统评价和荟萃分析研究中，我们旨在评估初始SRS失败后，重复立体定向放射外科治疗（SRS）在进展性VS中的疗效和结果。

方法

检索了PubMed/Medline、Scopus、Embase和Web of Science（WOS）的电子数据库，检索时间从数据库建立至2024年8月23日。纳入评估重复SRS在VS治疗中作用的研究。使用干预性非随机研究中的偏倚风险工具评估偏倚风险。使用R程序进行荟萃分析、敏感性分析、发表偏倚分析和荟萃回归分析。

结果

我们的研究共纳入11项研究，涉及260例接受重复SRS治疗的VS患者。初次和重复SRS之间的中位时间间隔为43至62个月，肿瘤体积范围不等。我们的分析显示，综合肿瘤控制率为91%（95%CI：86%-94%）。在放射学反应方面，综合退缩率为59%（95%CI：52%-65%），而综合进展率为9%（95%CI：6%-14%）。在临床结果方面，综合有效听力保留（SHP）率为36%（95%CI：22%-53%），而第五颅神经（CN）和第七颅神经恶化率分别为12%（95%CI：7%-19%）和8%（95%CI：5%-12%）。此外，综合不良放射效应（ARE）率为6%（95%CI：3%-11%）。