SRS、WBRT 及 WBRT ＋SRS 治疗1～4个脑转移瘤的 Meta 分析

目的：探讨立体定向放射外科（SRS）、全脑放疗（WBRT）及全脑放疗联合立体定向治疗1～4个脑转移瘤，并为进一步研究提供循证医学依据。方法：根据设定的纳入、排除标准，在 PubMed、Springer －link、Cancer list 数据库、中国生物医学文献数据库（CBM）、万方数据库、CNKI 知识网络服务平台及其他期刊进行相关随机对照试验检索。单变量计数资料的效应量用优势比（OR）和95％可信区间（95％CI）表示，用 Rev-man 5．2软件对数据进行异质性检验后采用固定效应模型或随机效应模型对数据进行分析。结果：共检索出1985－2014年间发表的126篇相关文献，最终得到8篇包含1213例脑转移瘤患者的随机对照试验符合所纳入的标准。SRS 与 WBRT ＋SRS 比较：WBRT ＋SRS 虽能提高脑转移瘤1年局部控制率及远处肿瘤控制率（OR ＝0．43，95％CI：0．29～0．63，P ＜0．0001；OR ＝0．42，95％CI：0．30～0．57，P ＜0．00001）；但不能提高1年生存率且不良反应及神经认知异常发生率高（OR ＝1．27，95％CI：0．93～1．73，P ＝0．14；OR ＝0．50，95％CI：0．28～0．89，P ＝0．02；OR ＝0．41，95％CI：0．21～0．78，P ＝0．006）。SRS 与 WBRT 比较：SRS 治疗脑转移瘤可明显提高患者1年生存率及1年局部肿瘤控制率，但远处肿瘤控制率与WBRT相当（OR＝2．78，95％CI：1．57～4．92，P ＝0．0004；OR ＝4．8，95％CI：2．69～8．57，P ＜0．00001；OR ＝0．52，95％CI：0．15～1．83，P ＝0．31）。WBRT ＋SRS 与单独 WRBT 比较：1年局部肿瘤控制率及1年生存率无明显差别（OR ＝1．23，95％CI：0．81～1．86，P ＝0．32；OR ＝1．21，95％CI：0．76～1．93，P ＝0．42）。结论：1～4个脑转移瘤患者，单独 SRS 是理想治疗方法。

Stereotactic radiosurgery,whole brain radiotherapy,or both for patients with one ~four brain metastatic tumors:A Meta -analysis

Objective:Disscussing stereotactic radiosurgery,whole brain radiotherapy or both for patients with one-four brain metastatic tumors,and providing a basis for evidence -based medicine for further research.Methods:We searched all the published randomized controlled trials in PubMed,Springer -link,Cancer list,China Biology Medi-cine disc,Wan -fang data base,CNKI and other periodicals,according to the included and excluded formulated stand-ards.The effects size (ES)univariate enumeration data were expressed as odds ratio (OR)and 95% confidence in-terval (95%CI).Undergoing the heterogeneity test by using Revman 5.2,we analyzed the data with fixed effect model or random effect model.Results:After retrievaling and preliminary screening,we retrieved total number of 126 relev-ent references which were published from 1985 to 2014.We got 8 articles including the result of randomized controlled trials of 1 213 cases of patients with brain metastatic tumors,according with the excluded standard through screening eventually.Through comparing SRS and WBRT +SRS ,although WBRT +SRS can improve local control rates and distant brain metastases(OR =0.43,95%CI:0.29 ~0.63,P <0.000 1.OR =0.42,95%CI:0.30 ~0.57,P <0.000 01),it still can't improve the 1 year survival rate and have high incidence of adverse reactions and neurocogni-tive anomalies(OR =1.27,95%CI:0.93 ~1.73,P =0.14.OR =0.50,95%CI:0.28 ~0.89,P =0.02.OR =0.41, 95%CI:0.21 ~0.78,P =0.006).Through comparing SRS and WBRT,the 1 year survival rate as well as local tumor control rates of brain metastases patients can be increased significantly by SRS treatment,but distant tumor control rates were almost equal to the WBRT(OR =2.78,95%CI:1.57 ~4.92,P =0.000 4.OR =4.8,95%CI:2.69 ~8.57,P <0.000 01.OR =0.52,95%CI:0.15 ~1.83,P =0.31).Comparing WBRT +SRS with WBRT,there was no obvious difference between local tumor control rates and 1 year survival rate(OR =1.23,95%CI:0.81 ~1.86, P =0.32.OR =1.21,95%CI:0.76 ~1.93,P =0.42).Conclusion:The ideal treatment for patients with 1 ~4 brain metastatic tumors is the solo SRS treatment.