Comparison of Gamma Knife (GK) and Linear Accelerator (LINAC) radiosurgery of brain metastasis resection cavity: a systematic review and proportional meta-analysis.

IF 4.2 3区 医学 Q2 ONCOLOGY
Clinical & Experimental Metastasis Pub Date : 2024-02-01 Epub Date: 2023-11-09 DOI:10.1007/s10585-023-10240-8
Rajiv Dharnipragada, Kathryn Dusenbery, Yoichi Watanabe, Clara Ferreira, Clark C Chen
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引用次数: 0

Abstract

Purpose: Stereotactic radiosurgery (SRS) to the resection cavity is essential in the treatment of brain metastasis (BM) amenable to surgical resection. The two most common platforms for SRS delivery include Gamma Knife (GK) and LINAC. Here we collated the available peer-reviewed literature and performed a meta-analysis on clinical outcomes after GK or LINAC resection cavity SRS.

Methods: Following PRISMA Guidelines, a search on PUBMED and MEDLINE was performed to include all studies evaluating each post-operative SRS modality. Local control, overall survival, radiation necrosis, and leptomeningeal disease were evaluated from the available data. A proportional meta-analysis was performed via R using the metafor package to pool the outcomes of studies and a moderator effect to assess the significance between groups.

Results: We identified 21 GK studies (n = 2009) and 28 LINAC studies (n = 2219). The radiosurgery doses employed were comparable between GK and LINAC studies. The pooled estimate of 1-year local control, 1-year overall survival, and risk of leptomeningeal disease were statistically comparable between GK and LINAC (81.7 v 85.8%; 61.4 v 62.7%; 10.6 v 12.5%, respectively). However, the risk of radiation necrosis (RN) was higher for LINAC resection cavity SRS (5.4% vs. 10%, p = 0.036). The volume of the resection cavity was a significant modifying factor for RN in both modalities (p = 0.007) with a 0.5% and 0.7% increase in RN risk with every 1 cm3 increase in tumor volume for GK and LINAC, respectively.

Conclusions: Our meta-analysis suggests that GK and LINAC SRS of resection cavity achieve comparable 1-year local control and survival. However, resection cavity treated with GK SRS was associated with lowered RN risk relative to those treated with LINAC SRS.

Abstract Image

伽玛刀(GK)和直线加速器(LINAC)脑转移切除腔放射外科的比较:一项系统综述和比例荟萃分析。
目的:切除腔的立体定向放射外科(SRS)在治疗可手术切除的脑转移瘤(BM)中至关重要。SRS交付的两个最常见的平台包括伽玛刀(GK)和LINAC。在这里,我们整理了现有的同行评审文献,并对GK或LINAC切除腔SRS后的临床结果进行了荟萃分析。方法:根据PRISMA指南,对PUBMED和MEDLINE进行了搜索,以包括评估每种术后SRS模式的所有研究。根据现有数据评估局部控制、总生存率、放射性坏死和软脑膜疾病。通过R进行比例荟萃分析,使用metafor软件包汇总研究结果,并使用调节效应评估组间的显著性。结果:我们确定了21项GK研究(n = 2009)和28项LINAC研究(n = 2219)。GK和LINAC研究中使用的放射外科剂量具有可比性。GK和LINAC对1年局部控制、1年总生存率和软脑膜疾病风险的汇总估计具有统计学可比性(分别为81.7对85.8%、61.4对62.7%、10.6对12.5%)。然而,LINAC切除腔SRS的放射坏死(RN)风险更高(5.4%vs.10%,p = 0.036)。在两种模式下,切除腔的体积是RN的一个显著修正因素(p = 0.007),GK和LINAC的肿瘤体积每增加1cm3,RN风险分别增加0.5%和0.7%。结论:我们的荟萃分析表明,切除腔的GK和LINAC SRS实现了相当的1年局部控制和生存率。然而,与LINAC SRS治疗相比,GK SRS治疗的切除腔与RN风险降低有关。
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来源期刊
CiteScore
7.80
自引率
5.00%
发文量
55
审稿时长
12 months
期刊介绍: The Journal''s scope encompasses all aspects of metastasis research, whether laboratory-based, experimental or clinical and therapeutic. It covers such areas as molecular biology, pharmacology, tumor biology, and clinical cancer treatment (with all its subdivisions of surgery, chemotherapy and radio-therapy as well as pathology and epidemiology) insofar as these disciplines are concerned with the Journal''s core subject of metastasis formation, prevention and treatment.
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