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Abstract：
OBJECTIVE: Radiation necrosis (RN) is a local inflammatory reaction that arises in response to radiation injury and may cause significant morbidity. This study aims to evaluate and compare the efficacy of bevacizumab and laser interstitial thermal therapy (LITT) in treating RN in patients with previously radiated central nervous system (CNS) neoplasms.
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.
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.
摘要：
目的：放射性坏死（RN）是一种局部炎症反应，是对放射性损伤的反应，可能会引起明显的发病率。这项研究旨在评估和比较贝伐单抗和激光间质热疗法（LITT）在先前辐射的中枢神经系统（CNS）肿瘤患者中治疗RN的疗效。
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.
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.
