METHODS: PubMed, Cochrane, Scopus, and EMBASE databases were screened. Studies of patients with radiation necrosis from primary or secondary brain tumors were included. Indirect meta-analysis with random-effect modeling was performed to compare clinical and radiological outcomes.
RESULTS: Twenty-four studies were included with 210 patients in the bevacizumab group and 337 patients in the LITT group. Bevacizumab demonstrated symptomatic improvement/stability in 87.7% of cases, radiological improvement/stability in 86.2%, and steroid wean-off in 45%. LITT exhibited symptomatic improvement/stability in 71.2%, radiological improvement/stability in 64.7%, and steroid wean-off in 62.4%. Comparative analysis revealed statistically significant differences favoring bevacizumab in symptomatic improvement/stability (p = 0.02), while no significant differences were observed in radiological improvement/stability (p = 0.27) or steroid wean-off (p = 0.90). The rates of adverse reactions were 11.2% for bevacizumab and 14.9% for LITT (p = 0.66), with the majority being grade 2 or lower (72.2% for bevacizumab and 62.5% for LITT).
CONCLUSIONS: Both bevacizumab and LITT exhibited favorable clinical and radiological outcomes in managing RN. Bevacizumab was found to be associated with better symptomatic control compared to LITT. Patient-, diagnosis- and lesion-related factors should be considered when choosing the ideal treatment modality for RN to enhance overall patient outcomes.
方法:PubMed,科克伦,Scopus,和EMBASE数据库进行了筛选。包括原发性或继发性脑肿瘤放射性坏死患者的研究。使用随机效应模型进行间接荟萃分析以比较临床和放射学结果。
结果:纳入24项研究,贝伐单抗组210例,LITT组337例。贝伐单抗在87.7%的病例中表现出症状改善/稳定性,放射学改善/稳定性在86.2%,45%的类固醇断奶。LITT表现出71.2%的症状改善/稳定性,放射学改善/稳定性在64.7%,和62.4%的类固醇断奶。比较分析显示,贝伐单抗在症状改善/稳定性方面存在统计学上的显着差异(p=0.02),而在放射学改善/稳定性(p=0.27)或类固醇戒断(p=0.90)方面没有观察到显着差异。贝伐单抗和LITT的不良反应发生率分别为11.2%和14.9%(p=0.66)。大多数为2级或更低(贝伐单抗为72.2%,LITT为62.5%)。
结论:贝伐单抗和LITT在管理RN方面均表现出良好的临床和放射学结果。与LITT相比,贝伐单抗与更好的症状控制相关。耐心-,在选择理想的RN治疗模式以提高患者的总体预后时,应考虑诊断和病变相关因素.