背景:基于Cyberknife的机器人放射外科(RRS)由于其高精度,是一种广泛用于成人中枢神经系统(CNS)各种良性和恶性肿瘤的治疗方式,良好的安全性,和功效。尽管RRS在小儿神经肿瘤学中正在出现,治疗适应症的科学证据,处理参数,和病人的结果是稀缺的。本系统综述总结了RRS和机器人立体定向放射治疗(RSRT)在小儿神经肿瘤学中的当前经验和证据。
方法:我们基于OvidMedline数据库进行了系统综述,Embase,科克伦图书馆,和PubMed以确定有关小儿神经肿瘤学中RRS和RSRT治疗的研究和发表的文章。本文应用了系统评价和荟萃分析(PRISMA)指南的首选报告项目。如果他们描述了RRS和RSRT在小儿神经肿瘤患者中的应用,则包括文章。使用原始和改编版本的纽卡斯尔渥太华质量评估量表(NOS),根据其证据水平和偏倚风险来评估文章的质量。仅包含在2021年8月1日之前发表的文章。
结果:在最终审查和删除重复后,共纳入23篇文章。文章报道了具有各种治疗适应症的各种CNS实体。大多数出版物缺乏大量样本量和前瞻性研究设计。几份报告包括成年患者,从而限制了儿科患者数据提取和分析的可能性。RRS和RSRT主要用于佐剂的设置,姑息治疗,和抢救治疗,具有良好的局部控制率和可接受的短期至中期毒性。然而,随访时间有限。所有研究的证据水平均为IV;NOS评分介于4到6之间,而总体偏倚风险为中等至较低.
结论:关于RRS和RSRT及其在小儿神经肿瘤学中的应用的出版物很少见,并且缺乏关于实体相关治疗标准和长期结局的高质量证据。有限的数据表明RRS和RSRT可能是有效的治疗方式,特别是对于不适合手术的儿童,患有肿瘤复发,或者需要姑息治疗。然而,选择此类治疗时,必须牢记潜在的短期和长期不良事件.前瞻性研究对于确定RRS和RSRT在小儿神经肿瘤学中的实际用途是必要的。
BACKGROUND: CyberKnife-based robotic radiosurgery (RRS) is a widely used treatment modality for various benign and malignant tumors of the central nervous system (CNS) in adults due to its high precision, favorable safety profile, and efficacy. Although RRS is emerging in pediatric neuro-oncology, scientific evidence for treatment indications, treatment parameters, and patient outcomes is scarce. This systematic
review summarizes the current experience and evidence for RRS and robotic stereotactic radiotherapy (RSRT) in pediatric neuro-oncology.
METHODS: We performed a systematic
review based on the databases Ovid Medline, Embase, Cochrane Library, and PubMed to identify studies and published articles reporting on RRS and RSRT treatments in pediatric neuro-oncology. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied herein. Articles were included if they described the application of RRS and RSRT in pediatric neuro-oncological patients. The quality of the articles was assessed based on their evidence level and their risk for bias using the original as well as an adapted version of the Newcastle Ottawa Quality Assessment Scale (NOS). Only articles published until 1 August 2021, were included.
RESULTS: A total of 23 articles were included after final
review and removal of duplicates. Articles reported on a broad variety of CNS entities with various treatment indications. A majority of publications lacked substantial sample sizes and a prospective study design. Several reports included adult patients, thereby limiting the possibility of data extraction and analysis of pediatric patients. RRS and RSRT were mostly used in the setting of adjuvant, palliative, and salvage treatments with decent local control rates and acceptable short-to-intermediate-term toxicity. However, follow-up durations were limited. The evidence level was IV for all studies; the NOS score ranged between four and six, while the overall risk of bias was moderate to low.
CONCLUSIONS: Publications on RRS and RSRT and their application in pediatric neuro-oncology are rare and lack high-quality evidence with respect to entity-related treatment standards and long-term outcomes. The limited data suggest that RRS and RSRT could be efficient treatment modalities, especially for children who are unsuitable for surgical interventions, suffer from tumor recurrences, or require palliative treatments. Nevertheless, the potential short-term and long-term adverse events must be kept in mind when choosing such a treatment. Prospective studies are necessary to determine the actual utility of RRS and RSRT in pediatric neuro-oncology.