Abstract：
Recurrent glioblastoma (rGBM) is a brain tumor that is resistant to standard treatments. Although stereotactic radiosurgery (SRS) is a non-invasive radiation technique, it cannot fully prevent tumor recurrence and progression. Bevacizumab blocks tumor blood supply and has been approved for rGBM. However, the best way to combine SRS and bevacizumab is still unclear. We did a systematic review and meta-analysis of studies comparing SRS alone and SRS plus bevacizumab for rGBM. We searched three databases for articles published until June 2023. All statistical analysis was performed by STATA v.17. Our meta-analysis included 20 studies with 926 patients. We found that the combination therapy had a significantly lower rate of overall survival (OS) than SRS alone at 6-month 0.77[95%CI:0.74-0.85] for SRS alone and (100%) for SRS plus bevacizumab. At 1-year OS, 0.39 [95%CI: 0.32-0.47] for SRS alone and 0.61 [95%CI:0.44-0.77] for SRS plus bevacizumab (P-value:0.02). However, this advantage was not seen in the long term (18 months and two years). Additionally, the combination therapy had lower chances of progression-free survival (PFS) than SRS alone at the 6-month and 1-year time points, but the differences were insignificant. Our study indicates that incorporating bevacizumab with SRS may lead to a short-term increase in OS for rGBM patients but not long-term. Additionally, the PFS rate did not show significant improvement in the group receiving combination therapy. Further clinical trials are necessary to validate the enhanced overall survival with combination therapy for rGBM.
摘要：
复发性成胶质细胞瘤(rGBM)是对标准治疗有抗性的脑肿瘤。尽管立体定向放射外科（SRS）是一种非侵入性的放射技术，它不能完全预防肿瘤复发和进展。贝伐单抗阻断肿瘤血液供应，已被批准用于rGBM。然而,联合使用SRS和贝伐单抗的最佳方法仍不清楚.我们对单独SRS和SRS加贝伐单抗治疗rGBM的研究进行了系统评价和荟萃分析。我们搜索了三个数据库，查找直到2023年6月发表的文章。所有统计分析均由STATAv.17进行。我们的荟萃分析包括20项研究，926例患者。我们发现，联合治疗在6个月时的总生存率（OS）明显低于单独的SRS，单独的SRS为0.77[95CI：0.74-0.85]，SRS加贝伐单抗为（100％）。在1年操作系统，仅SRS为0.39[95CI：0.32-0.47]，SRS加贝伐单抗为0.61[95CI：0.44-0.77]（P值：0.02）。然而,这种优势在长期(18个月和2年)没有出现。此外,在6个月和1年的时间点，联合治疗的无进展生存期（PFS）的机会低于单独的SRS，但是差异微不足道。我们的研究表明，将贝伐单抗与SRS结合可能导致rGBM患者的OS短期增加，但不是长期增加。此外,接受联合治疗组的PFS率没有显著改善.需要进一步的临床试验来验证rGBM联合治疗的总体生存率的提高。
