立体定向放疗联合与不联合全脑放疗治疗脑转移瘤效果的Meta分析

Meta-analysis of stereotactic radiosurgery with or without whole-brain radiotherapy for patients presenting brain metastases

目的：对比分析全脑放疗（WBRT）联合立体定向放疗（SRS）与单独SRS治疗脑转移瘤效果。方法通过检索Pubmed、Cochrane图书馆、Embase、中国生物医学文献数据库、中文科技期刊数据库以及中国期刊全文数据库等在线数据库,收集SRS联合与不联合WBRT治疗脑转移瘤的随机临床对照研究并由两名评价者对疗效及安全性有关数据进行提取及质量评估,采用RevMan 5.3软件进行Meta分析。结果经过系统筛选,最终纳入5篇文献,472例脑转移瘤患者。盲法缺失影响纳入研究的总体质量。合并分析结果表明院与单独SRS相比,WBRT联合SRS在提高1年颅内疾病无进展生存方面差异有统计学意义（OR =3.66,95%CI 1.80-7.45,P=0.0003）。 SRS联合与不联合WBRT对改善1年总体生存率（OR =0.78,95%CI 0.24-2.52,P=0.6700）及2年总体生存率差异无统计学意义（OR =1.12,95%CI 0.35-3.55,P=0.8500）。生存分析表明,SRS联合与不联合WBRT对总体生存率的影响差异无统计学意义（HR =1.17,95%CI 0.96-1.41,P=0.1100）。结论 WBRT联合SRS用于治疗脑转移瘤,可显著降低脑转移瘤进展风险,但对总体生存时间无显著改善。

Objective To evaluate the efficacy and safety of WBRT combined with SRS versus SRS alone for the treat-ment of brain metastases. Methods Online databases including Pubmed, Embase, the Cochrane library, the Chinese biomedical literature database, China Scientific Journal Database and Chinese Journal Full-text Database were searched, and randomized controlled clinical trials relevant to treatment of brain metastases by SRS and/or WBRT were identified. Data of curative effect and safety were extracted and quality assessment was performed by two reviewers in-dependently. RevMan 5.3 software was used for the final combination analysis. Results A total of 5 articles involving 472 cases of patients with brain metastases were included. The bias of loss of blinding was the main source of low quality with regards to the overall quality of included studies. The results of the Meta-analysis showed that compared with the SRS alone, WBRT plus SRS was significantly more superior in controlling the 1-year intracranial disease pro-gression-free survival, the difference was statistically significant （OR = 3.66, 95%CI 1.80-7.45, P= 0.0003）. SRS in combination with WBRT failed to significantly improve the 1-year overall survival, the difference was statistically sig-nificant （OR =0.78, 95%CI 0.24-2.52, P=0.6700）, and 2-year overall survival, the difference was statistically signifi-cant （OR = 1.12, 95%CI 0.35-3.55, P= 0.8500）. Pooled survival analysis showed that neither SRS plus WBRT nor SRS was significantly effective in improving overall survival, the difference was statistically significant （HR = 1.17, 95%CI 0.96-1.41, P=0.1100）. Adding WBRT to SRS had no obvious effect on neural function, quality of life, and in-cidence of neurological adverse events. Conclusion WBRT plus SRS can significantly improve the 1-year intracranial disease progression-free survival, but has limited improvement on overall survival for patients with brain metastases.