Medical Student UT Southwestern Medical Center Dallas, TX, US
Introduction: Radiolabeled monoclonal antibodies represent a targeted immunotherapy approach for recurrent primary brain tumors, and may offer lower rates of radiotoxicity compared to conventional radiation due to proximity to the tumor bed. However, the incidence of radiotoxicity and the overall safety profile of this approach remain largely unknown.
Methods: A comprehensive literature search was conducted across PubMed, Google Scholar, Cochrane, and Scopus databases, adhering to PRISMA guidelines, with random-effects meta-analysis assessing the incidence of radionecrosis. All reported results are pooled estimates.
Results: From 1004 screened studies, 11 studies were included in our review, including 3 retrospective and 8 prospective trials of radioimmunotherapy (RIT), encompassing 577 patients. The mean patient age was 40.1 years (95% CI:[23.47-56.75]), with two pediatric studies. Most treated tumors were glioblastomas (320/577, 64.8%, 95%CI:[44.68-84.86]), and Grade III and other gliomas (112/577, 16.0%, 95%CI:[8.15-23.91]). Recurrent tumors comprised 70.1% (298/404, 95%CI:[44.11-95.99]) of cases. Radionuclides were administered intracavitarily (284/577, 54.85%, 95%CI:[25.02-84.69] or intraventricularly (293/577, 48.66%, 95%CI:[13.22-84.10]). By the end of study duration, radionecrosis occurred in 8 patients (1.4%) (8/577, 0.05%, 95%CI:[0.0-0.01]); no other severe outcomes were reported. 68 transient grade 3 or higher effects were reported, including thrombocytopenia (44/577, 9.14%, 95%CI:[0-19.62]), myelotoxicity (12/577, 1.21%, 95%CI:[0.16-2.26]), seizures (12/577, 0.58%, 95%CI:[0-1.18]), and focal neurologic deficits (7/577, 0.63%, 95%CI:[0-1.3]).
Conclusion : To our knowledge, this is the first comprehensive meta-analysis to suggest that radio-immunotherapy is associated with a low incidence of radiotoxicity, indicating a potential alternative strategy to conventional radiation for recurrent primary brain tumors.
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