目的:高级别神经胶质瘤(HGG)是中枢神经系统的侵袭性肿瘤,可引起显著的发病率和死亡率。尽管手术和放射治疗(RT)取得了进展,HGG仍有较高的复发和治疗失败的发生率。术中放疗(IORT)已成为一种有前途的治疗方法,可实现局部肿瘤控制,同时使正常脑组织免受辐射引起的损伤。
方法:根据PRISMA指南进行系统评价和荟萃分析,以评估IORT对HGG的使用。根据具体标准纳入符合条件的研究,并独立提取数据。感兴趣的结果包括并发症,IORT失败,12个月和24个月的生存率,和死亡率。
结果:包括436例患者的16项研究。IORT术后总并发症发生率为17%,观察到显著的异质性。IORT故障率为77%,而12个月和24个月的生存率分别为74%和24%,分别。死亡率为62%。
结论:这项荟萃分析表明,IORT可能是对某些HGG患者的有希望的辅助治疗。尽管并发症和治疗失败的发生率很高,生存结局与常规方法相当,甚至优于常规方法.然而,研究的局限性,例如缺乏对照组和小样本量,我们需要通过前瞻性随机对照试验进行进一步调查,以更好地了解可能从IORT获益最多的特定患者人群.然而,研究的局限性,例如缺乏对照组和小样本量,需要进一步调查。值得注意的是,正在进行的RP3试验(NCT02685605)目前正在进行中,目的是更全面地了解IORT。此外,未来的研究应集中于管理与IORT相关的并发症,以提高其治疗HGG的安全性和有效性.
OBJECTIVE: High-grade gliomas (HGGs) are aggressive tumors of the central nervous system that cause significant morbidity and mortality. Despite advances in surgery and radiation therapy (RT), HGG still has a high incidence of recurrence and treatment failure. Intraoperative radiotherapy (IORT) has emerged as a promising therapeutic approach to achieve local tumor control while sparing normal brain tissue from radiation-induced damage.
METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the use of IORT for HGG. Eligible studies were included based on specific criteria, and data were independently extracted. Outcomes of interest included complications, IORT failure, survival rates at 12 and 24 months, and mortality.
RESULTS: Sixteen studies comprising 436 patients were included. The overall complication rate after IORT was 17%, with significant heterogeneity observed. The IORT failure rate was 77%, while the survival rates at 12 and 24 months were 74% and 24%, respectively. The mortality rate was 62%.
CONCLUSIONS: This meta-analysis suggests that IORT may be a promising adjuvant treatment for selected patients with HGG. Despite the high rate of complications and treatment failures, the survival outcomes were comparable or even superior to conventional methods. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation through prospective randomized controlled trials to better understand the specific patient populations that may benefit most from IORT. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation. Notably, the ongoing RP3 trial (NCT02685605) is currently underway, with the aim of providing a more comprehensive understanding of IORT. Moreover, future research should focus on managing complications associated with IORT to improve its safety and efficacy in treating HGG.