Abstract：
BACKGROUND: Whole-brain radiotherapy (WBRT) is a standard and effective approach for brain metastases, but it is linked to neurocognitive complications, specifically issues related to the hippocampus. Innovative strategies are being explored to enhance outcomes. However, a consensus is yet to be reached in this field. Our aim is to investigate the efficacy and safety of WBRT combined with simultaneous integrated boost (SIB), memantine, and hippocampal avoidance (HA) techniques in treatment of brain metastases.
METHODS: In this systematic review and meta-analysis, we comprehensively searched PubMed, MEDLINE, Embase, and Cochrane for studies reporting the efficacy and toxicity of WBRT-based combination therapies from inception to September 19, 2023. Data were pooled using random-effects models. Results were reported as risk ratios (RRs) and risk differences (RDs) for dichotomous outcomes, along with their 95% confidence intervals (CIs). Heterogeneity was evaluated using the I2 statistic.
RESULTS: Among 2175 articles, 29 studies involving 3460 patients were included. The meta-analysis revealed that compared to WBRT alone, combination therapies significantly mitigated neurocognitive function decline (RD = -0.09, 95% CI [-0.18-0.01]; P = 0.03) and intracranial control failure (RR = 0.86, 95% CI [0.52-1.44]; P = 0.02), without increasing the risk of hippocampal recurrence or high-grade toxicities. Notably, HA-WBRT + SIB/memantine demonstrated improved neurocognitive outcomes and survival benefits.
CONCLUSIONS: WBRT-based combination therapies demonstrate improved efficacy and comparable safety to WBRT alone, with specific emphasis on the effectiveness of HA-WBRT + Memantine and HA-WBRT + SIB in optimizing therapeutic outcomes for brain metastases.
METHODS: In this systematic review and meta-analysis, we comprehensively searched PubMed, MEDLINE, Embase, and Cochrane for studies reporting the efficacy and toxicity of WBRT-based combination therapies from inception to September 19, 2023. Data were pooled using random-effects models. Results were reported as risk ratios (RRs) and risk differences (RDs) for dichotomous outcomes, along with their 95% confidence intervals (CIs). Heterogeneity was evaluated using the I2 statistic.
RESULTS: Among 2175 articles, 29 studies involving 3460 patients were included. The meta-analysis revealed that compared to WBRT alone, combination therapies significantly mitigated neurocognitive function decline (RD = -0.09, 95% CI [-0.18-0.01]; P = 0.03) and intracranial control failure (RR = 0.86, 95% CI [0.52-1.44]; P = 0.02), without increasing the risk of hippocampal recurrence or high-grade toxicities. Notably, HA-WBRT + SIB/memantine demonstrated improved neurocognitive outcomes and survival benefits.
CONCLUSIONS: WBRT-based combination therapies demonstrate improved efficacy and comparable safety to WBRT alone, with specific emphasis on the effectiveness of HA-WBRT + Memantine and HA-WBRT + SIB in optimizing therapeutic outcomes for brain metastases.
摘要：
背景：全脑放疗（WBRT）是治疗脑转移的一种标准且有效的方法，但它与神经认知并发症有关，特别是海马体相关的问题。正在探索创新战略，以加强成果。然而,在这一领域尚未达成共识。我们的目的是研究WBRT联合同步综合增强（SIB）的疗效和安全性，美金刚,和海马回避（HA）技术治疗脑转移。
方法：在本系统综述和荟萃分析中，我们全面搜索了PubMed，MEDLINE,Embase,和Cochrane用于报告从开始到2023年9月19日基于WBRT的联合疗法的疗效和毒性的研究。使用随机效应模型汇集数据。结果报告为风险比（RR）和风险差异（RD）的二分结果，以及他们的95%置信区间(CI)。使用I2统计量评估异质性。
结果：在2175篇文章中，纳入了涉及3460名患者的29项研究。荟萃分析显示，与单独的WBRT相比，联合治疗可显着缓解神经认知功能下降（RD=-0.09，95％CI[-0.18-0.01];P=0.03）和颅内控制失败（RR=0.86，95％CI[0.52-1.44];P=0.02），不会增加海马复发或高级别毒性的风险。值得注意的是,HA-WBRT+SIB/美金刚表现出改善的神经认知结果和生存益处。
结论：以WBRT为基础的联合疗法与单独使用WBRT相比，显示出更高的疗效和相当的安全性。特别强调HA-WBRT+美金刚和HA-WBRT+SIB在优化脑转移治疗结果方面的有效性。
方法：在本系统综述和荟萃分析中，我们全面搜索了PubMed，MEDLINE,Embase,和Cochrane用于报告从开始到2023年9月19日基于WBRT的联合疗法的疗效和毒性的研究。使用随机效应模型汇集数据。结果报告为风险比（RR）和风险差异（RD）的二分结果，以及他们的95%置信区间(CI)。使用I2统计量评估异质性。
结果：在2175篇文章中，纳入了涉及3460名患者的29项研究。荟萃分析显示，与单独的WBRT相比，联合治疗可显着缓解神经认知功能下降（RD=-0.09，95％CI[-0.18-0.01];P=0.03）和颅内控制失败（RR=0.86，95％CI[0.52-1.44];P=0.02），不会增加海马复发或高级别毒性的风险。值得注意的是,HA-WBRT+SIB/美金刚表现出改善的神经认知结果和生存益处。
结论：以WBRT为基础的联合疗法与单独使用WBRT相比，显示出更高的疗效和相当的安全性。特别强调HA-WBRT+美金刚和HA-WBRT+SIB在优化脑转移治疗结果方面的有效性。
