Purpose

This evidence report synthesizes the available evidence on radiation therapy for brain metastases.

Methods and Materials

The literature search included PubMed, EMBASE, Web of Science, Scopus, CINAHL, clinicaltrials.gov, and published guidelines in July 2020; independently submitted data, expert consultation, and contacting authors. Included studies were randomized controlled trials (RCTs) and large observational studies (for safety assessments), evaluating whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination, as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma.

Results

Ninety-seven studies reported in 189 publications were identified, but the number of analyses was limited owing to different intervention and comparator combinations as well as insufficient reporting of outcome data. Risk of bias varied, and 25 trials were terminated early, predominantly owing to poor accrual. The combination of SRS plus WBRT compared with SRS alone or WBRT alone showed no statistically significant difference in overall survival (hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.69%-1.73%; 4 RCTs) or death owing to brain metastases (relative risk [RR], 0.93; 95% CI, 0.48%-1.81%; 3 RCTs). Radiation therapy after surgery did not improve overall survival compared with surgery alone (HR, 0.98; 95% CI, 0.76%-1.26%; 5 RCTs). Data for quality of life, functional status, and cognitive effects were insufficient to determine effects of WBRT, SRS, or postsurgery interventions.

We did not find systematic differences across interventions in serious adverse events, number of adverse events, radiation necrosis, fatigue, or seizures. WBRT plus systemic therapy (RR 1.44; 95% CI, 1.03%-2.00%; 14 studies) was associated with increased risks for vomiting compared with WBRT alone.

Conclusions

Despite the substantial research literature on radiation therapy, comparative effectiveness information is limited. There is a need for more data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.

中文翻译：

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脑转移瘤的放射治疗：系统评价

目的

该证据报告综合了有关脑转移瘤放射治疗的现有证据。

方法和材料

文献检索包括 PubMed、EMBASE、Web of Science、Scopus、CINAHL、clinicaltrials.gov，并于 2020 年 7 月发布指南；独立提交数据、专家咨询和联系作者。纳入的研究是随机对照试验 (RCT) 和大型观察性研究（用于安全性评估），单独或联合评估全脑放射治疗 (WBRT) 和立体定向放射外科手术 (SRS) 作为初始或术后治疗，有或没有全身治疗因肺癌、乳腺癌或黑色素瘤而发生脑转移的成人。

结果

确定了 189 篇出版物中报告的 97 项研究，但由于不同的干预和比较组合以及结果数据报告不足，分析数量有限。偏倚风险各不相同，25 项试验提前终止，主要是由于应计不良。与单独 SRS 或单独 WBRT 相比，SRS 加 WBRT 的组合在总生存率（风险比 [HR]，1.09；95% 置信区间 [CI]，0.69%-1.73%；4 个 RCT）或因死亡脑转移（相对风险 [RR]，0.93；95% CI，0.48%-1.81%；3 个 RCT）。与单独手术相比，手术后的放射治疗并未提高总生存率（HR，0.98；95% CI，0.76%-1.26%；5 个 RCT）。生活质量、功能状态、

我们没有发现干预措施在严重不良事件、不良事件数量、辐射坏死、疲劳或癫痫发作方面存在系统性差异。与单独的 WBRT 相比，WBRT 加全身治疗（RR 1.44；95% CI，1.03%-2.00%；14 项研究）与呕吐风险增加相关。

结论

尽管有大量关于放射治疗的研究文献，但比较有效性信息是有限的。需要更多关于患者相关结果的数据，例如生活质量、功能状态和认知影响。