The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.
The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.
复制标题
立体定向放射外科手术在新诊断的脑转移患者的管理中的作用：系统审查和基于证据的临床实践指南。
DOI：
10.1007/s11060-009-0073-4
复制
发表时间：
2010-01
影响因子：
3.9
通讯作者：
Kalkanis, Steven N.
中科院分区：
文献类型：
--
作者：
Linskey, Mark E.;Andrews, David W.;Asher, Anthony L.;Burri, Stuart H.;Kondziolka, Douglas;Robinson, Paula D.;Ammirati, Mario;Cobbs, Charles S.;Gaspar, Laurie E.;Loeffler, Jay S.;McDermott, Michael;Mehta, Minesh P.;Mikkelsen, Tom;Olson, Jeffrey J.;Paleologos, Nina A.;Patchell, Roy A.;Ryken, Timothy C.;Kalkanis, Steven N.
关键词：
与其他治疗方法相比，新诊断的脑转移瘤患者是否应该接受立体定向放射外科治疗(SRS)？目标人群这些建议适用于新诊断为符合SRS的实体性脑转移的成年人；符合SRS的病灶通常定义为最大直径小于3厘米，并产生最小的(中线移位小于1厘米)质量效应。建议对于KPS为≥=70的单一转移性脑肿瘤患者，与单纯西药放疗相比，西药加西药放疗与1级单剂量西药放疗相比，可显著延长患者的存活期。在≥为70的1-4个转移性脑肿瘤患者中，与单纯西药放疗相比，2级单剂放疗与西药放疗相比，在局部肿瘤控制和维持功能状态方面更优越。对于2-3个转移性脑瘤的患者，3级单剂量SRS联合WBRT可能比单独WBRT显著延长患者的生存时间。级别4有III级证据表明，对于单发或多发脑转移瘤和70岁以下的KPS患者，单剂SRS和WBRT联合WBRT在改善患者生存方面优于单独WBRT。SRS加WBRT与SRS单独使用2级单剂SRS相比，与WBRT+单剂SRS相比，单独使用2级SRS可能会为脑转移瘤患者提供同等的生存优势。当单独使用SRS时，有相互矛盾的I类和II类证据表明局部和远程复发的风险，而I类证据表明WBRT的远程复发风险较低；因此，有必要对单独接受SRS治疗的患者进行定期仔细监测，以便及早识别局部和远程复发，以便尽早开始抢救治疗。手术切除加WBRT和SRS+WBRT 2级手术切除加WBRT和SRS+WBRT都是有效的治疗策略，导致相对相等的生存率。对于较大的病变(>；3厘米)或那些引起显著质量效应的(>；1厘米中线偏移)，SRS还没有从循证的角度进行评估。级别3：力量不足的I类证据以及相互冲突的II类证据的优势表明，对于单个脑转移瘤患者，仅SRS可能提供与切除+WBRT相同的功能和生存结果，只要有可能随时检测到远处部位故障和挽救SRS。单独SRS与单独WBRT 3级虽然单剂SRS和WBRT对治疗脑转移患者都有效，但就患者生存优势而言，单剂量SRS似乎优于单独WBRT治疗多达3个转移性脑瘤。
Should patients with newly-diagnosed metastatic brain tumors undergo stereotactic radiosurgery (SRS) compared with other treatment modalities? Target population These recommendations apply to adults with newly diagnosed solid brain metastases amenable to SRS; lesions amenable to SRS are typically defined as measuring less than 3 cm in maximum diameter and producing minimal (less than 1 cm of midline shift) mass effect. Recommendations SRS plus WBRT vs. WBRT alone Level 1 Single-dose SRS along with WBRT leads to significantly longer patient survival compared with WBRT alone for patients with single metastatic brain tumors who have a KPS ≥ 70. Level 2 Single-dose SRS along with WBRT is superior in terms of local tumor control and maintaining functional status when compared to WBRT alone for patients with 1–4 metastatic brain tumors who have a KPS ≥ 70. Level 3 Single-dose SRS along with WBRT may lead to significantly longer patient survival than WBRT alone for patients with 2–3 metastatic brain tumors. Level 4 There is class III evidence demonstrating that single-dose SRS along with WBRT is superior to WBRT alone for improving patient survival for patients with single or multiple brain metastases and a KPS < 70. SRS plus WBRT vs. SRS alone Level 2 Single-dose SRS alone may provide an equivalent survival advantage for patients with brain metastases compared with WBRT + single-dose SRS. There is conflicting class I and II evidence regarding the risk of both local and distant recurrence when SRS is used in isolation, and class I evidence demonstrates a lower risk of distant recurrence with WBRT; thus, regular careful surveillance is warranted for patients treated with SRS alone in order to provide early identification of local and distant recurrences so that salvage therapy can be initiated at the soonest possible time. Surgical Resection plus WBRT vs. SRS ± WBRT Level 2 Surgical resection plus WBRT, vs. SRS plus WBRT, both represent effective treatment strategies, resulting in relatively equal survival rates. SRS has not been assessed from an evidence-based standpoint for larger lesions (>3 cm) or for those causing significant mass effect (>1 cm midline shift). Level 3: Underpowered class I evidence along with the preponderance of conflicting class II evidence suggests that SRS alone may provide equivalent functional and survival outcomes compared with resection + WBRT for patients with single brain metastases, so long as ready detection of distant site failure and salvage SRS are possible. SRS alone vs. WBRT alone Level 3 While both single-dose SRS and WBRT are effective for treating patients with brain metastases, single-dose SRS alone appears to be superior to WBRT alone for patients with up to three metastatic brain tumors in terms of patient survival advantage.
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DOI：
10.1016/s0360-3016(96)85008-5
发表时间：
1996-04-01
影响因子：
7
作者：
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Mehta, MP
DOI：
10.1097/01.coc.0000128863.75360.a5
发表时间：
2004-08-01
影响因子：
2.6
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影响因子：
120.7
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DOI：
10.1016/s0360-3016(96)00619-0
发表时间：
1997-03-01
影响因子：
7
作者：
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通讯作者：
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DOI：
10.1016/s0360-3016(00)00804-x
发表时间：
2000-12-01
影响因子：
7
作者：
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