| Chao Wan,Biao Chen,Yuanshi Liu,Ximing Xu. Whole-brain radiation therapy alone vs. combined therapy with stereotactic radiosurgery for the treatment of limited brain metastases: A systematic review. Oncol Transl Med, 2019, 5: 114-118. |
| 全脑放疗联合或不联合立体定向放射外科治疗有限脑转移的系统评价 |
| Whole-brain radiation therapy alone vs. combined therapy with stereotactic radiosurgery for the treatment of limited brain metastases: A systematic review |
| Received:March 24, 2019 Revised:July 04, 2019 |
| DOI：10.1007/s10330-019-0344-4 |
| 中文关键词: 有限脑转移；立体定向放射外科治疗；全脑放疗；系统评价； |
| 英文关键词: limited brain metastases; stereotactic radiosurgery (SRS); whole brain radiotherapy (WBRT); systematic review |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Chao Wan | Renmin Hospital of Wuhan University | 583186126@qq.com | | Biao Chen | Renmin Hospital of Wuhan University | | | Yuanshi Liu | Renmin Hospital of Wuhan University | | | Ximing Xu* | Renmin Hospital of Wuhan University | doctorxu120@aliyun.com |
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| 中文摘要: |
| 目的: 本文旨在系统评价全脑放疗联合或不联合立体定向放射外科治疗有限脑转移（1-4枚脑转移）的疗效及安全性. 方法：检索含有全脑放疗联合立体定向放射外科治疗对比单纯全脑放疗的随机对照研究及配对分析型文献。从检索得到的文献中的生存曲线中提取关于总生存、颅内控制、局部控制等主要终点指标的数据，采用倒方差的方法在RevMan 5.3软件中进行统计合成分析。对于其他不能合成的数据采用描述性分析。
结果：共纳入3篇随机对照型临床研究及两项配对分析研究。合成结局显示：无论对于1-3脑转移还是2-4个有限脑转移，两组总存并无差异，风险比分别为 0.91(95% CI 0.76 -1.09, p=0.32)和 0.72(95% CI 0.44 -1.19, p=0.20)。而关于局部控制和颅内病灶控制，统计合成结果显示联合治疗组更具有优势，风险比分别为0.69(95% CI 0.55-0.86, p=0.001)和0.41(95% CI 0.29 -0.58,p<0.0001)。尤其值得注意的是，一项随机对照研究显示：对于单发脑转移，全脑放疗联合立体定向放射外科治疗在总生存方面获益明显（中位生存：6.5m vs 4.9m, p=0.04)。
在毒副反应方面，立体定向放射外科治疗的加入似乎并未增加副反应的发生率。
结论： 对于有限脑转移（1-4）的病人，基于更好局部控制、颅内控制以及并不增加的毒副反应发生率，全脑放疗联合立体定向放射外科治疗应该被优先推荐。特别是对于单发脑转移， 相对于单纯全脑放疗，立体定向放射外科治疗的加入在延长生存方面具有优势， 应该作为一种常规治疗选择。 |
| 英文摘要: |
| Objective The aim of the study was to compare the efficacy and safety of whole brain radiotherapy
(WBRT) used alone and combined with stereotactic radiosurgery (SRS) in the treatment of limited (1–4)
brain metastases.
Methods We searched for randomized controlled and matched-pair analysis trials comparing WBRT
plus SRS versus WBRT alone for brain metastases. The primary outcomes were the overall survival (OS),
intracranial control (IC), and localcontrol (LC). The secondary outcome was radiation toxicity. The log
hazard ratios (lnHRs) and their variances were extracted from published Kaplan-Meier curves and pooled
using the generic inverse variance method in the RevMan 5.3 software. The non-pooled outcome measures
were evaluated using descriptive analysis.
Results Three randomized controlled trials and two matched-pair analysis studies were included. There
was no difference in the OS for limited brain metastases between the two groups [lnHR 0.91 (95% CI
0.76–1.09, P = 0.32) vs. 0.72 (95% CI 0.44–1.19, P = 0.20)]. The LC and IC were significantly higher in
the combined treatment group [lnHR 0.69 (95% CI 0.55–0.86, P = 0.001) vs. 0.41 (95% CI 0.29–0.58, P
< 0.0001)]. For patients with a single lesion, one trial showed a higher survival in the combined treatment
group (median OS: 6.5 months vs. 4.9 months, P = 0.04). The combined treatment was not associated with
significantly higher incidence of radiation toxicity.
Conclusion Combined treatment with WBRT plus SRS should be recommended for patients with limited
brain metastases based on the better LC and IC without increased toxicity. It should also be considered a
routine treatment option for patients with solitary brain metastases based on the prolonged OS. |
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