| Objective: CNS metastases(brain metastases)in adults are the most common form of intracranial tumors.The brain metastases may occur in 25%-35% malignant patients.Based on the clinical practice guidelines recently updated by the National Comprehensive Cancer Network,for the treatment of central nervous system tumors,especially for patients with inoperable,radiation therapy is the most important form of therapy.The purpose of this study was to evaluate the overall survival and the quality of life after the patients were treated with whole brain radiation therapy(WBRT)or stereotactic radiotherapy(SRT),or WBRT combined with SRT,to provide the evidence of best treatment options for these patients.Methods: Formulate search queries based on research purposes,to search the clinical study about the WBRT,SRT,or WBRT combined with SRT in the major search database,to select the included studies,extracted data and take RevMan5.0 Meta-analysis software for data analysis according to the inclusion and exclusion criteria.Results:31 studies including 24695 patients were selected for Meta analysis in the end.The Meta analysis results show that:(1)SRT compared with WBRT: WBRT can increase the risk of death of all the patients with HR=1.63(95%CI 1.34-1.99,P<0.00001),for 1-3 brain metastases patients,there was no significant difference between the two radiotherapy programs HR=1.48(95%CI 0.89-2.43,P=0.130);the LC of patients with brain metastases is reduce by the WBRT,HR=2.06(95%CI 1.24-3.43,P=0.006).There was no significant difference in ≥3 grade radiation toxicity between the two groups OR=1.84(95%CI 0.75-4.51,P=0.180).(2)WBRT+SRT compared with WBRT: The results yielded an obvious difference between the WBRT+SRT group and WBRT group in OS of all of the patients and 1-3 brain metastases with an HR=0.78(95%CI 0.70-0.87,P<0.0001)and HR=0.82(95%CI 0.70-0.95,P=0.009).WBRT combine with SRT could enhance the LC,HR=0.30(95%CI 0.20-0.44,P<0.00001).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=0.230),the late toxicities with an OR=1.25(95%CI 0.58-2.72,P=0.570),and the total OR=0.86(95%CI 0.57-1.30,P=0.480).(3)WBRT+SRT compared with SRT: There was no significant difference in OS between the two treatments for all patients and those with 1-3 brain metastases: HR= 0.96(95%CI 0.88-1.06,P=0.420),HR=0.96(95%CI 0.84-1.10,P=0.570).Combined radiotherapy plan has obvious advantages in tumor control rate of LC HR=0.82(95%CI 0.69-0.97,P=0.020).While the DC rate has no significant difference HR=0.89(95%CI 0.72-1.09,P=0.260).For the 1-3 metastases group,there was showed no significant difference in LC and DC between the two groups with a HR=1.01(95%CI 0.77-1.32,P=0.960),and HR=1.09(95%CI 0.80-1.49,P=0.580).The incidence rate of radiation toxicities(≥Grade 2)showed no significant difference between the two groups OR=1.18(95%CI 0.78-1.79,P=0.440).Conclusions: Among the three radiotherapy regimens,WBRT+SRT had a significant advantage in OS and LC,and the number of brain metastases was not an absolute limitation.The advantages of SRT compared with WBRT were more prominent,improve the overall survival of patients and local control rate.There is no significant difference of radiation-related toxicity between each other. |
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