Radiotherapeutic management of brain metastases: A systematic review and meta-analysis

被引:114
|
作者
Tsao, MN
Lloyd, NS
Wong, RKS
Rakovitch, E
Chow, E
Laperriere, N
机构
[1] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8S 4L8, Canada
[2] Toronto Sunnybrook Reg Canc Ctr, Dept Radiat Oncol, Toronto, ON M4N 3M5, Canada
[3] Univ Toronto, Dept Radiat Oncol, Toronto, ON M5S 3E2, Canada
[4] Princess Margaret Hosp, Dept Radiat Oncol, Toronto, ON M5G 2M9, Canada
[5] Canc Care Ontario Program Evidence Based Care, Hamilton, ON L8S 4L8, Canada
关键词
brain metastases; radiation; systematic review; meta-analysis;
D O I
10.1016/j.ctrv.2005.04.007
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The management of brain metastases is a significant health care problem. An estimated 20-40% of cancer patients will develop metastatic cancer to the brain during the course of their illness. Methods: A systematic review of randomized trials on adult cancer patients with single or multiple brain metastases from cancer of any histology was conducted. Eligible studies investigated external beam radiotherapy or radiosurgery in one of the study arms. Outcomes of interest included survival, intracranial progression-free duration, response of brain metastases to therapy, quality of life, symptom control, neurological function, and toxicity. Results: Twenty-seven trials were included in this systematic review of the evidence. Pooled results from three randomized trials of surgical excision combined with whole brain radiotherapy (WBRT) showed no improvement in overall survival as compared to WBRT alone in patients with single brain metastasis. One randomized study of postoperative WBRT following excision of a single brain metastasis versus surgery atone detected a significant reduction in intracraniat tumour recurrence rates but no corresponding difference in overall survival. Nine trials of altered dose-fractionation schedules compared to a standard control fractionation schedule (3000 cGy in 10 fractions) of WBRT showed no difference in probability of survival at 6 months. The addition of radiosensitizers, as assessed in five trials, did not confer additional benefit to WBRT in terms of overall survival or the frequency of brain metastases response. Three trials examined the use of WBRT and radiosurgery boost versus WBRT alone in selected patients with brain metastases. Overall survival did not improve for patients with multiple brain metastases. However, one trial reported an improvement in survival for patients with single brain metastasis treated with WBRT and radiosurgery boost. One older randomized trial examined the use of WBRT versus supportive care alone (using oral prednisone). Results were not conclusive. Conclusion: For patients with a single brain metastasis, good performance status, and minimal or no evidence of extracranial disease, surgical excision and postoperative WBRT improves survival (as compared to WBRT atone). There may be a small survival advantage associated with the use of radiosurgery boost and WBRT as compared to WBRT atone in selected patients with a single brain metastasis. There is no difference in overall survival or in neurologic function improvement with the use of altered whole brain dose-fractionation schedules as compared to standard fractionation schedules (3000 cGy in 10 fractions or 2000 cGy in 5 fractions). There is no survival. benefit associated with the use of radiosurgery boost and WBRT versus WBRT atone in patients with multiple brain metastases. Currently, neither chemotherapy nor radiosensitizers show a clear benefit in the objective parameters of survival and progression-free survival. For patients with poor performance status and active extracranial disease, steroids and supportive care are an option. (C) 2005 Elsevier Ltd. All rights reserved.
引用
收藏
页码:256 / 273
页数:18
相关论文
共 50 条
  • [1] RESECTION FOR RECURRENT BRAIN METASTASES: A SYSTEMATIC REVIEW AND META-ANALYSIS
    Ida, F.
    Hulsbergen, A.
    Lamba, N.
    Mekary, R.
    Smith, T. R.
    [J]. VALUE IN HEALTH, 2020, 23 : S24 - S25
  • [2] Genetic Alterations of Melanoma Brain Metastases: A Systematic Review and Meta-Analysis
    Laura Pala
    Vincenzo Bagnardi
    Francesca Tettamanzi
    Massimo Barberis
    Giovanni Mazzarol
    Cecilia Casali
    Tommaso De Pas
    Elisabetta Pennacchioli
    Sara Coppola
    Federica Baldini
    Emilia Cocorocchio
    Pierfrancesco Ferrucci
    Damiano Patane’
    Maristella Saponara
    Paola Queirolo
    Fabio Conforti
    [J]. Molecular Diagnosis & Therapy, 2023, 27 : 5 - 13
  • [3] Combination of radiotherapy and immunotherapy for brain metastases: A systematic review and meta-analysis
    Petrelli, Fausto
    De Stefani, Agostina
    Trevisan, Francesca
    Parati, Chiara
    Inno, Alessandro
    Merelli, Barbara
    Ghidini, Michele
    Bruschieri, Lorenza
    Vitali, Elisabetta
    Cabiddu, Mary
    Borgonovo, Karen
    Ghilardi, Mara
    Barni, Sandro
    Ghidini, Antonio
    [J]. CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 2019, 144
  • [4] Genetic Alterations of Melanoma Brain Metastases: A Systematic Review and Meta-Analysis
    Pala, Laura
    Bagnardi, Vincenzo
    Tettamanzi, Francesca
    Barberis, Massimo
    Mazzarol, Giovanni
    Casali, Cecilia
    De Pas, Tommaso
    Pennacchioli, Elisabetta
    Coppola, Sara
    Baldini, Federica
    Cocorocchio, Emilia
    Ferrucci, Pierfrancesco
    Patane', Damiano
    Saponara, Maristella
    Queirolo, Paola
    Conforti, Fabio
    [J]. MOLECULAR DIAGNOSIS & THERAPY, 2023, 27 (01) : 5 - 13
  • [5] Electrochemotherapy for the palliative management of cutaneous metastases: A systematic review and meta-analysis
    Morley, Josephine
    Grocott, Patricia
    Purssell, Edward
    Murrells, Trevor
    [J]. EJSO, 2019, 45 (12): : 2257 - 2267
  • [6] Brain metastases in the setting of stable extracranial disease: A systematic review and meta-analysis
    Li, Alyssa Y.
    Gaebe, Karolina
    Zulfiqar, Amna
    Lee, Grace
    Jerzak, Katarzyna Joanna
    Sahgal, Arjun
    Erickson, Anders W.
    Das, Sunit
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2022, 40 (16)
  • [7] Leptomeningeal disease in neurosurgical brain metastases patients: A systematic review and meta-analysis
    Tewarie, Ishaan Ashwini
    Jessurun, Charissa A. C.
    Hulsbergen, Alexander F. C.
    Smith, Timothy R.
    Mekary, Rania A.
    Broekman, Marike L. D.
    [J]. NEURO-ONCOLOGY ADVANCES, 2021, 3 (01)
  • [8] Deep Learning for Detecting Brain Metastases on MRI: A Systematic Review and Meta-Analysis
    Ozkara, Burak B. B.
    Chen, Melissa M. M.
    Federau, Christian
    Karabacak, Mert
    Briere, Tina M. M.
    Li, Jing
    Wintermark, Max
    [J]. CANCERS, 2023, 15 (02)
  • [9] Surgical Management of Synchronous Colorectal Liver Metastases - A Systematic Review and Meta-Analysis
    Allu, Veera
    [J]. BRITISH JOURNAL OF SURGERY, 2022, 109
  • [10] Hypothermia in the management of traumatic brain injuryA systematic review and meta-analysis
    William R. Henderson
    Vinay K. Dhingra
    Dean R. Chittock
    John C. Fenwick
    Juan J. Ronco
    [J]. Intensive Care Medicine, 2003, 29 : 1637 - 1644