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.
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。