Abstract：
Stereotactic Radiosurgery (SRS) delivers a high dose of radiation to a specific brain area while limiting radiation to nearby healthy tissue. While most SRS has traditionally been performed with a stereotactic frame-based approach, this study aims to investigate the safety and efficacy of frameless radiosurgery in patients with brain metastases. Our study followed the recommended guidelines summarized in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The electronic databases of PubMed/Medline, Scopus, Embase, and Web of Science (WOS) were searched from inception to 10 October 2023. The pooled rate of outcomes was calculated using random effect model and Restricted maximum-likelihood (REML) method. All statistical analysis was performed by STATA V.17. A total of 499 studies were recruited from the electronic databases. After removing duplicates (n = 117), 382 studies were used for title/abstract, and 329 were removed from the study selection process. A total of 53 articles were used for full-text assessment, and 35 studies were included for data extraction. Our analysis revealed a significant increase across all pooled survival rates and local control rates by initiating the radiosurgery for patients, estimating the pooled 6-month OSR of 75% (95% CI: 68-81%), 1-year overall survival rate (OSR) of 60% (95% CI: 51-69%), 18-month OSR of 48% (95% CI: 10-85%), 2-year OSR of 39% (95% CI: 19-58%), 1-year progression-free survival rate (PFSR) of 68% (95% CI: 39-98%), 2-year PFSR of 75% (95% CI: 58-91%), 6-month local control rate (LCR) of 93% (95% CI: 90-96%), and 12-month LCR of 86% (95% CI: 82-90%). Our meta-analysis findings confirm the efficacy of frameless radiosurgery in treating brain metastases. Using data from several trials, we were able to demonstrate stereotactic radiosurgery\'s effectiveness as a therapy option for brain metastasis patients, demonstrating local control and reasonable overall survival.
摘要：
立体定向放射外科（SRS）向特定的大脑区域提供高剂量的辐射，同时将辐射限制在附近的健康组织。虽然大多数SRS传统上是使用基于立体定向框架的方法执行的，本研究旨在探讨无框放射外科治疗脑转移瘤患者的安全性和有效性。我们的研究遵循了系统审查和荟萃分析（PRISMA）清单中推荐的指南。PubMed/Medline的电子数据库，Scopus,Embase,和WebofScience(WOS)从开始到2023年10月10日进行了搜索。使用随机效应模型和限制最大似然(REML)方法计算合并结果率。所有统计分析均由STATAV.17进行。从电子数据库中总共招募了499项研究。删除重复项（n=117）后，382项研究用于标题/摘要，和329从研究选择过程中删除。共有53篇文章用于全文评估，并纳入35项研究进行数据提取。我们的分析显示，通过开始对患者进行放射外科治疗，所有合并生存率和局部控制率均显着提高。估计汇总的6个月OSR为75%(95%CI：68-81%)，1年总生存率（OSR）为60％（95％CI：51-69％），18个月OSR为48%（95%CI：10-85%），2年OSR为39%（95%CI：19-58%），1年无进展生存率（PFSR）为68％（95％CI：39-98％），2年PFSR为75%（95%CI：58-91%），6个月局部控制率（LCR）为93％（95％CI：90-96％），12个月LCR为86%（95%CI：82-90%）。我们的荟萃分析结果证实了无框放射外科治疗脑转移瘤的疗效。利用几个试验的数据，我们能够证明立体定向放射外科作为脑转移患者的治疗选择的有效性，显示局部控制和合理的总体生存。
