BACKGROUND AND PURPOSE To perform a systematic review/meta-analysis of outcomes for patients with spinal metastases treated with stereotactic radiosurgery (SRS) (either single-fraction (SF-SRS) or multiple-fraction (MF-SRS)) or conventional radiotherapy (RT). MATERIALS AND METHODS Thirty-seven studies were identified. Primary outcomes were 1-year local control (LC) and acute/late grade 3-5 toxicities (including vertebral compression fractures (VCF)). Weighted random effects meta-analyses using the DerSimonian and Laird methods and meta-regressions were conducted to characterize and compare effect sizes. Mixed effects regression models were used in dose analyses. RESULTS A total of 3237 patients with 4911 lesions were included; 43.8%, 19.7%, and 36.5% of lesions received SF-SRS, MF-SRS, or RT, respectively. SF-SRS resulted in improved 1-year LC (92.9% (95% CI: 86.4-97.4%); p = 0.007) compared to RT (81.0% (95% CI: 69.2-90.5%)) with no difference between MF-SRS (82.1%; p = 0.86) and RT. On subgroup analysis of de novo metastases, superior 1-year LC following SF-SRS (95.5% (95% CI: 87.4-99.6%)) was maintained compared to RT (83.6% (95% CI: 70.4-93.5%); p = 0.007). A 4.7% increase in LC was noted for each 10 Gy10 increase in biologically effective dose (BED10, assuming an alpha/beta = 10) with SRS (p < 0.001). No difference in toxicities were found between SF-SRS (0.4%), MF-SRS (0.2%), or RT (0%). Higher VCF rates were noted following SF-SRS (19.5%) vs. MF-SRS (9.6%; p = 0.039)) with no correlation between dose and VCF rates. CONCLUSION SF-SRS resulted in superior LC with a roughly 5% LC benefit for every 10 Gy10 increase in BED10 with higher VCF rates compared to MF-SRS. If LC is the goal of treatment, then SRS may be a preferred treatment modality. However, these results are hypothesis-generating, and prospective randomized clinical trials are indicated to definitively address the question of whether SRS results in improved LC compared to RT.

中文翻译：

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脊柱寡转移的单次放射外科、分割放射外科和常规放射治疗 (SAFFRON)：系统评价和荟萃分析

背景和目的 对接受立体定向放射外科 (SRS)（单次 (SF-SRS) 或多次 (MF-SRS)）或常规放疗（SRS）治疗的脊柱转移瘤患者的结果进行系统评价/荟萃分析（转）。材料和方法 确定了 37 项研究。主要结果是 1 年局部控制 (LC) 和急性/晚期 3-5 级毒性（包括椎体压缩骨折 (VCF)）。使用 DerSimonian 和 Laird 方法和元回归进行加权随机效应荟萃分析，以表征和比较效应大小。混合效应回归模型用于剂量分析。结果共纳入患者3237例，病灶4911处；分别有 43.8%、19.7% 和 36.5% 的病灶接受了 SF-SRS、MF-SRS 或 RT。SF-SRS 改善了 1 年 LC (92. 9%（95% CI：86.4-97.4%）；p = 0.007) 与 RT (81.0% (95% CI: 69.2-90.5%)) 相比，MF-SRS (82.1%; p = 0.86) 和 RT 之间没有差异。在对新发转移的亚组分析中，SF-SRS 后的 1 年 LC（95.5%（95% CI：87.4-99.6%））与 RT（83.6%（95% CI：70.4-93.5%））相比得以维持； p = 0.007）。在 SRS 的情况下，生物有效剂量（BED10，假设 α/β = 10）每增加 10 Gy10，LC 就会增加 4.7%（p < 0.001）。在 SF-SRS (0.4%)、MF-SRS (0.2%) 或 RT (0%) 之间没有发现毒性差异。在 SF-SRS (19.5%) 与 MF-SRS (9.6%; p = 0.039)) 之后注意到更高的 VCF 率，剂量和 VCF 率之间没有相关性。结论 与 MF-SRS 相比，SF-SRS 产生了优越的 LC，BED10 每增加 10 Gy10 LC 获益约 5%，VCF 率更高。如果 LC 是治疗的目标，那么 SRS 可能是首选的治疗方式。然而，这些结果是产生假设的，前瞻性随机临床试验表明，与 RT 相比，SRS 是否能改善 LC 的问题。