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首页> 外文期刊>Systematic Reviews >The impact of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis
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The impact of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis

机译：常规监视筛查与磁共振成像（MRI）检测对中枢神经系统（CNS）肿瘤患儿肿瘤复发的影响：系统评价和荟萃分析的方案

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Background The aim of this study is to assess the impact of routine MRI surveillance to detect tumour recurrence in children with no new neurological signs or symptoms compared with alternative follow-up practices, including periodic clinical and physical examinations and the use of non-routine imaging upon presentation with disease signs or symptoms. Methods Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Ten electronic databases have been searched, and further citation searching and reference checking will be employed. Randomised and non-randomised controlled trials assessing the impact of routine surveillance MRI to detect tumour recurrence in children with no new neurological signs or symptoms compared to alternative follow-up schedules including imaging upon presentation with disease signs or symptoms will be included. The primary outcome is time to change in therapeutic intervention. Secondary outcomes include overall survival, surrogate survival outcomes, response rates, diagnostic yield per set of images, adverse events, quality of survival and validated measures of family psychological functioning and anxiety. Two reviewers will independently screen and select studies for inclusion. Quality assessment will be undertaken using the Cochrane Collaboration’s tools for assessing risk of bias. Where possible, data will be summarised using combined estimates of effect for time to treatment change, survival outcomes and response rates using assumption-free methods. Further sub-group analyses and meta-regression models will be specified and undertaken to explore potential sources of heterogeneity between studies within each tumour type if necessary. Discussion Assessment of the impact of surveillance imaging in children with CNS tumours is methodologically complex. The evidence base is likely to be heterogeneous in terms of imaging protocols, definitions of radiological response and diagnostic accuracy of tumour recurrence due to changes in imaging technology over time. Furthermore, the delineation of tumour recurrence from either pseudo-progression or radiation necrosis after radiotherapy is potentially problematic and linked to the timing of follow-up assessments. However, given the current routine practice of MRI surveillance in the follow-up of children with CNS tumours in the UK and the resource implications, it is important to evaluate the cost-benefit profile of this practice. Systematic review registration PROSPERO CRD42016036802
机译：背景技术这项研究的目的是评估常规MRI监测对没有新神经系统症状或症状的儿童与其他后续随访方法（包括定期临床和体格检查以及使用非常规影像学检查）相比发现肿瘤复发的影响。出现疾病迹象或症状时。方法将采用旨在减少偏倚的标准系统评价方法进行研究鉴定，选择和数据提取。已经搜索了十个电子数据库，并将使用进一步的引文搜索和参考检查。包括随机评估和非随机对照试验，评估常规监视MRI对无新神经系统症状或体征的儿童与其他随访方案（包括在出现疾病体征或症状时进行影像学检查）相比，检测肿瘤复发的影响。主要结果是改变治疗干预措施的时间。次要结局包括总体生存，替代生存结局，反应率，每组图像的诊断率，不良事件，生存质量以及家庭心理功能和焦虑的有效量度。两名审稿人将独立筛选并选择要纳入的研究。将使用Cochrane协作组织的工具来评估质量，以评估偏差的风险。在可能的情况下，将使用无假设方法，使用对治疗改变时间，生存结果和缓解率的综合评估来汇总数据。如果需要的话，将指定进一步的亚组分析和荟萃回归模型，以探索每种肿瘤类型之间研究之间潜在的异质性来源。讨论对监视影像学对中枢神经系统肿瘤患儿的影响进行评估在方法上很复杂。由于成像技术随时间的变化，在成像方案，放射线反应的定义以及肿瘤复发的诊断准确性方面，证据基础可能是不同的。此外，放射治疗后假性进展或放射坏死对肿瘤复发的描述可能存在问题，并与随访评估的时间有关。然而，考虑到英国目前对患有CNS肿瘤的儿童进行MRI监测的常规做法及其资源影响，重要的是评估这种做法的成本效益概况。系统审查注册PROSPERO CRD42016036802

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