全脑放射治疗或联合立体定向放疗对脑转移瘤疗效评价的Meta分析

A Meta-Analysis Evaluating Whole-Brain Radiotherapy Combined with or without Stereotactic Radiotherapy for Patients with Brain Metastases

目的 评价脑转移瘤患者给予全脑放射治疗或联合立体定向放疗的疗效。方法 在各大数据库中搜索关于全脑放疗或其联合立体定向放疗的相关临床研究,提取数据并采取RevMan5.0软件进行Meta分析。结果 9篇文献纳入本研究,共25 415名患者;Meta分析结果示：全脑放射治疗联合立体定向放疗可明显提高患者的总生存期（风险比0.78,95%可信区间0.70-0.87,P〈0.000 1）,对于1-3个脑转移瘤患者联合放疗亦有明显优势（风险比0.82,95%可信区间 0.70-0.95,P=0.009）,联合放疗可提高局部控制率（风险比0.3,95%可信区间 0.20-0.44,P〈0.000 01）;联合放疗并未增加患者的2级以上放疗相关毒副反应发生率：急性毒副反应优势比0.74（95%可信区间 0.45-1.21,P=0.23）,晚期毒副反应优势比1.25（95%可信区间0.58-2.72,P=0.57）,总发生率合并效应量优势比0.86（95%可信区间0.57-1.30,P=0.48）。结论 全脑放射治疗联合立体定向放疗可明显提高患者（包括1-3个脑转移瘤患者）的总生存期及脑转移瘤的局部控制率,并未增加患者的毒副反应发生率。

Objective In order to evaluate the efficacy of WBRT＋SRT or WBRT alone for patients with brain metastases. Methods All qualified literatures about the WBRT combined with or without SRT were searched in every databases. RevMan 5.0 were used for this meta- analysis. Results After searching the databases and evaluating the articles, 9 studies including 25 415 patients were selected for meta analysis. The meta analysis results yielded an obvious difference between the WBRT＋SRT group and WBRT group in overall survival with an HR=0.78 （95%CI 0.70-0.87, P 〈 0.000 1）, for the 1-3 metastases group HR=0.82（95%CI 0.70-0.95, P=0.009）, and the local control with an HR=0.3 （95%CI 0.20-0.44, P 〈 0.000 01 ）. The incidence rate of radiation toxicities （〉Grade 2） showed no significant difference between the two groups： for the acute toxicities with an OR=0.74 （95%CI 0.45-1.21, P=0.23）, the late toxicities with an OR=1.25 （95% CI 0.58-2.72, P=0.57） , and the total OR=0.86 （95% CI 0.57-1.30, P=0.48）. Conclusions WBRT combined with SRT is better than WBRT alone for patients with brain metastases in the OS and LC. WBRT combined with SRT would not lead more serious radiation toxicities than WBRT alone.