脑转移(BM)是最常见的脑恶性肿瘤,也是癌症患者死亡的常见原因。然而,在BM的初始治疗中,手术切除(SR)和立体定向放射外科(SRS)的相对结局相关优势和劣势存在争议.
我们系统回顾了截至2020年3月的英语文献,以比较SR和SRS在BM初始治疗中的疗效。我们从Cochrane图书馆确定了队列研究,PubMed,和EMBASE数据库,并按照系统评价和荟萃分析(PRISMA)指南的首选报告项目进行荟萃分析。包括20项队列研究,涉及1,809例患者。局部控制在SR和SRS组之间没有显着差异(风险比[HR]1.02,95%置信区间(CI)0.64-1.64,p=0.92;I2=54%,p=0.03)或在SR加SRS的亚组分析中单独的SRS,SR加全脑放射治疗(WBRT)与SRS加WBRT,或SR加WBRT与单独的SRS。远端颅内控制在SR组和SRS组之间没有显着差异(HR0.78,95%CI0.38-1.60,p=0.49;I2=61%,p=0.03)或在SR加SRS与单独SRS或SR加WBRT与单独SRS的亚组分析中。此外,总生存期(OS)在SR和SRS组中没有显着差异(HR0.91,95%CI0.65-1.27,p=0.57;I2=47%,p=0.09)或在SR加SRS与单独SRS的亚组分析中,SR加WBRT与单独的SRS或SR加WBRT与SRS加WBRT。
在单发或孤立性BM患者中,初始用SRS治疗BM可提供与SR相当的局部和远端颅内控制。在具有单个或单独BM的人中,SR和SRS组之间的OS没有显着差异。
Brain metastasis (BM) is the most common brain malignancy and a common cause of death in cancer patients. However, the relative outcome-related advantages and disadvantages of surgical resection (SR) and stereotactic radiosurgery (SRS) in the initial treatment of BM are controversial.
We systematically reviewed the English language literature up to March 2020 to compare the efficacy of SR and SRS in the initial treatment of BM. We identified cohort studies from the Cochrane Library, PubMed, and EMBASE databases and conducted a meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Twenty cohort studies involving 1,809 patients were included. Local control did not significantly differ between the SR and SRS groups overall (hazard ratio [HR] 1.02, 95% confidence interval (CI) 0.64-1.64, p = 0.92; I2 = 54%, p = 0.03) or in subgroup analyses of SR plus SRS vs. SRS alone, SR plus whole brain radiation therapy (WBRT) versus SRS plus WBRT, or SR plus WBRT versus SRS alone. Distant intracranial control did not significantly differ between the SR and SRS groups overall (HR 0.78, 95% CI 0.38-1.60, p = 0.49; I2 = 61%, p = 0.03) or in subgroup analyses of SR plus SRS versus SRS alone or SR plus WBRT versus SRS alone. In addition, overall survival (OS) did not significantly differ in the SR and SRS groups (HR 0.91, 95% CI 0.65-1.27, p = 0.57; I2 = 47%, p = 0.09) or in subgroup analyses of SR plus SRS versus SRS alone, SR plus WBRT versus SRS alone or SR plus WBRT versus SRS plus WBRT.
Initial treatment of BM with SRS may offer comparable local and distant intracranial control to SR in patients with single or solitary BM. OS did not significantly differ between the SR and SRS groups in people with single or solitary BM.