TY - JOUR
T1 - Systematic Review and Meta-Analysis on the Use of Photon-based Stereotactic Radiosurgery Versus Fractionated Stereotactic Radiotherapy for the Treatment of Uveal Melanoma
AU - Kosydar, Samuel
AU - Robertson, Jake C.
AU - Woodfin, Michael
AU - Mayr, Nina A.
AU - Sahgal, Arjun
AU - Timmerman, Robert D.
AU - Lo, Simon S.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Purpose:The purpose of this report is to assess the efficacy and adverse event profile of photon-based stereotactic radiosurgery (SRS) compared with fractionated stereotactic radiotherapy (fSRT) for the treatment of uveal melanoma. Primary outcomes include incidence proportions of local control, enucleation, metastatic progression, disease-specific, and overall mortality. Treatment-related toxicities such as incidence proportions of radiation retinopathy, neovascular glaucoma, optic neuropathy, and cataract formation were examined as secondary outcomes. Five-year survival and 5-year local control rates were also assessed.Materials and Methods:PubMed, Embase, Web of Science, Scopus, and 2 Cochrane databases were searched up to December 31, 2018. Random effects models were used to calculate pooled incidence proportions of outcome measures. Meta-regression was carried out to explore the potential impact of dose per fraction on local control.Results:Twenty-four articles with a total of 1745 patients were included in the meta-analysis. There were no statistically significant differences between photon-based fSRT and SRS for all primary, secondary and 5-year outcome measures, including local control (P=0.28), enucleation (P=0.51), and neovascular glaucoma (P=0.40). The 5-year local control rate was 90% (95% confidence interval: 76%, 96%) for fSRT and 89% (70%, 97%) for SRS.Conclusions:Our meta-analysis showed no difference in tumor control, survival and toxicities, as defined in this paper, between SRS and fSRT for uveal melanoma. Confounding biases remain an expected limitation in this study of novel treatment modalities deployed in rare tumors. Further investigation is needed to validate outcomes and compare stereotactic treatment techniques.
AB - Purpose:The purpose of this report is to assess the efficacy and adverse event profile of photon-based stereotactic radiosurgery (SRS) compared with fractionated stereotactic radiotherapy (fSRT) for the treatment of uveal melanoma. Primary outcomes include incidence proportions of local control, enucleation, metastatic progression, disease-specific, and overall mortality. Treatment-related toxicities such as incidence proportions of radiation retinopathy, neovascular glaucoma, optic neuropathy, and cataract formation were examined as secondary outcomes. Five-year survival and 5-year local control rates were also assessed.Materials and Methods:PubMed, Embase, Web of Science, Scopus, and 2 Cochrane databases were searched up to December 31, 2018. Random effects models were used to calculate pooled incidence proportions of outcome measures. Meta-regression was carried out to explore the potential impact of dose per fraction on local control.Results:Twenty-four articles with a total of 1745 patients were included in the meta-analysis. There were no statistically significant differences between photon-based fSRT and SRS for all primary, secondary and 5-year outcome measures, including local control (P=0.28), enucleation (P=0.51), and neovascular glaucoma (P=0.40). The 5-year local control rate was 90% (95% confidence interval: 76%, 96%) for fSRT and 89% (70%, 97%) for SRS.Conclusions:Our meta-analysis showed no difference in tumor control, survival and toxicities, as defined in this paper, between SRS and fSRT for uveal melanoma. Confounding biases remain an expected limitation in this study of novel treatment modalities deployed in rare tumors. Further investigation is needed to validate outcomes and compare stereotactic treatment techniques.
KW - meta-analysis
KW - photon-based fractionated stereotactic radiotherapy
KW - photon-based stereotactic radiosurgery
KW - uveal melanoma
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U2 - 10.1097/COC.0000000000000775
DO - 10.1097/COC.0000000000000775
M3 - Review article
C2 - 33208706
AN - SCOPUS:85096703613
SN - 0277-3732
VL - 44
SP - 32
EP - 42
JO - American Journal of Clinical Oncology: Cancer Clinical Trials
JF - American Journal of Clinical Oncology: Cancer Clinical Trials
IS - 1
ER -