Amirmohammad Bahri

Anlotinib, a novel multi-target tyrosine kinase inhibitor, has shown promise in improving survival and managing associated complications. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of Anlotinib in patients with high-grade glioma, specifically glioblastoma (GBM). This study was conducted according to the PRISMA guidelines. A systematic search was conducted on PubMed, Embase, Web of Science, and Scopus up to 9 December 2024. The included studies were appraised and assessed for quality and potential bias and further statistical analyses were performed using STATA v.17. A total of 17 studies with 473 patients were recruited, which included 204 patients with GBM. The pooled analysis resulted in a 6-month OS of 67% (95% CI: 42–92%) and a 1-year OS equal to 50% (95% CI: 36–64%) from the Anlotinib treatment. Progression-free survival at 6 months was 61% (95% CI: 46–75%), and at 1 year was 27% (95% CI: 13–41%), also showing similar promising outcomes. The overall response rate (ORR) and disease control rate (DCR) were reported at 55% (95% CI: 44–67%) and 90% (95% CI: 87–94%), respectively. The sub-group analysis revealed that adding anlotinb to temozolomide (TMZ) and radiotherapy had superior outcomes regarding OS, PFS, and DCR. Moreover, the highest ORR and complete response rate were achieved by Anlotinib plus stereotactic radiosurgery. Anlotinib demonstrates considerable efficacy in extending survival and achieving disease control in high-grade glioma patients when added to radiotherapy and TMZ. These findings can support its inclusion in therapeutic regimens, warranting further investigation in large-scale randomized controlled trials.

Brain metastases (BM) pose a significant challenge due to limited treatment options and poor prognosis. Combining PD-1/PD-L1 inhibitors with stereotactic radiosurgery (SRS) may enhance tumor control through synergistic effects. This study assessed the efficacy and safety of this combined approach for BM. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Embase, Web of Science, and Scopus up to 27 June 2024. Studies involving PD-1/PD-L1 inhibitors and SRS for BM were included. Outcomes included local control (LC), progression-free survival (PFS), overall survival (OS), radiological response, and adverse events. Data were analyzed using STATA V.17 with a random-effects model. Sixteen studies with 1529 patients were included. Pooled 6- and 12-month LC rates were 85% (95% CI 75–95%) and 84% (95% CI 75–93%), respectively. One- and three-year PFS rates were both 51% (95% CI 39–64% and 41–62%), while one- and two-year OS rates were 67% (95% CI 57–78%) and 30% (95% CI 16–45%). Overall response rate was 61% (95% CI 44–78%), with a complete response rate of 39% (95% CI 25–53%). Adverse radiation effects occurred in 31% (95% CI 3–58%), with radiation necrosis in 12% (95% CI 2–23%). Subgroup analyses showed no significant impact of drug type, primary tumor site, prior treatment, or SRS fractionation on outcomes. Combining PD-1/PD-L1 inhibitors with SRS for BM yields robust local control and improved one-year survival compared to historical data, with manageable toxicities. However, variability in outcomes and lack of comparator groups highlight the need for standardized protocols and prospective trials to optimize treatment strategies and identify predictive biomarkers.

Background Predicting recurrence in meningioma patients is vital for improving long-term outcomes and tailoring personalized treatment strategies. While traditional diagnostic methods have advanced, accurately forecasting recurrence remains a persistent and critical challenge. This study explores the cutting-edge application of artificial intelligence (AI)-based models, which seamlessly integrate clinical, radiological, and pathological data, offering a transformative approach to enhancing the reliability and precision of recurrence prediction. Methods Eligible studies were identified through a comprehensive search of the Web of Science, Scopus, PubMed, and Embase databases. Extracted and synthesized metrics for analysis included accuracy, sensitivity, specificity, precision, F1 score, and area under the curve (AUC). Out of 2,971 studies screened, six met the inclusion criteria for systematic review, and three were included in the meta-analysis. Results The pooled sensitivity and specificity of AI models were 0.86 [95% CI: 0.78–0.92] and 0.86 [95% CI: 0.81–0.90], respectively. The positive diagnostic likelihood ratio (DLR) was 6.33 [95% CI: 4.42–9.08], and the negative DLR was 0.16 [95% CI: 0.09–0.27]. The diagnostic odds ratio (DOR) was estimated at 40.11 [95% CI: 19.30–83.37], with a diagnostic score of 3.69 [95% CI: 2.96–4.42] and a pooled area under the curve (AUC) of 0.93 [95% CI: 0.90–0.95]. Subgroup analysis showed comparable sensitivity (RF: 0.88; LR: 0.84) and specificity (RF: 0.84; LR: 0.84) with no significant heterogeneity (I² = 0%). Conclusions These findings highlight the potential of AI-based models to predict meningioma recurrence, offer superior diagnostic accuracy, and aid clinical decision-making. Integrating clinical, radiological, and pathological data through AI-driven models demonstrates substantial promise in enhancing the reliability and efficiency of recurrence forecasting.

Background Brain metastases (BMs) are a common and fatal consequence in patients with advanced malignancies. Mutations happening in the epidermal growth factor receptor (EGFR) are associated with an elevated risk BMs, occurring in approximately 20–40% of patients. This study evaluates the safety and efficacy of different radiotherapy (RT) modalities in patients with EGFR-mutant lung cancer brain metastases. Method This study was conducted according to the PRISMA guideline. A comprehensive search was conducted on PubMed, Embase, Web of Science, and Scopus, until 13 March 2024. Stata v.17 was used for statistical analysis. Result A total of 57 studies involving 4614 patients were analyzed, with a female predominance of 59.55% and a mean age of 50–70 years. The 6-month overall survival (OS) rate was 94% [95% CI 91–96%], 81% [95% CI 78– 84%] at 1-year, 55% [95% CI 50–60%] at 2-year, 37% [95% CI 32–42%] at 3-year, decreasing to 21% [95% CI 16–26%] at 5 years. Progression-free survival (PFS) rates were 84% [95% CI 79–89%] at 6 months and 20% [95% CI 14–26%] at 3 years. Meta-regression analysis indicated that a higher number of metastases, Karnofsky performance status below 80, and an ECOG score over one were significantly linked to OS outcomes. Conclusion RT significantly improves survival outcomes in patients with EGFR-mutant brain metastases. However, the combination of RT with targeted therapies, such as tyrosine kinase inhibitors (TKIs), appears to offer more favorable outcomes.

Background Intracranial atherosclerotic artery stenosis (ICAS) is a major cause of ischemic stroke globally and is associated with poor recanalization rates, high recurrence, and adverse functional outcomes. The use of stents has been explored as a treatment option to improve outcomes, despite concerns over procedure-related complications and in-stent restenosis (ISR). This study aimed to compare the efficacy and safety of drug-eluting stents (DES) versus bare metal stents (BMS) in treating patients with symptomatic ICAS (sICAS). Method A systematic review and meta-analysis were conducted according to PRISMA guidelines, with a comprehensive search of PubMed, Embase, and Web of Science up to March 1, 2024. Studies that reported outcomes such as technical and clinical success rates, periprocedural complications, ISR, and stroke rates were included. Statistical analysis was performed using Stata v.17. Results A total of 44 studies involving 13,658 patients were included. DES demonstrated lower pooled rates of major stroke (3% [95% CI 2–4%]) and ISR (8% [95% CI 3–12%]) compared to BMS (5% [95% CI 3–6%] for major stroke and 19% [95% CI 14–24%] for ISR), though the difference in major stroke rate was not statistically significant. The clinical success rate was similar between DES (89% [95% CI 78–99%]) and BMS (86% [95% CI 76–97%]). Technical success rates were high and comparable for both stent types. Subgroup analyses and meta-regression identified significant factors influencing heterogeneity, including stent or wire length and diameter. Conclusion DES showed a significant advantage over BMS in reducing ISR and major stroke rates while maintaining comparable safety and technical success. These findings support the preferential use of DES in clinical practice for managing sICAS, emphasizing their role in enhancing patient outcomes through reduced restenosis and recurrent ischemic events.

Individuals with non-small cell lung cancer (NSCLC) who develop brain metastases face a poor prognosis and limited treatment options. Programmed cell death protein 1 (PD-1) inhibitors, such as pembrolizumab and nivolumab, have emerged as a promising immunotherapy for treating lung cancer with brain metastases. This systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and evaluate the safety and efficacy of anti-PD-1/PD-L1 monoclonal antibodies in treating lung cancer patients with brain metastases. A comprehensive literature search was conducted to identify relevant studies up to 27 August 2023. Data on overall survival (OS), progression-free survival, radiological response rates, and adverse events were extracted. All statistical analysis was performed using STATA v.17. Our literature search yielded 39 eligible studies involving 15,428 patients. The overall response rate for PD-1 inhibitors was substantial, with pooled rates of 39% for overall response, 7% for complete response (CR), 27% for partial response (PR), and 31% for stable disease (SD). The pooled 6-month OS rate was 77%, and the 1-year OS rate was 61%. Subgroup analyses revealed higher PD-L1 expression levels and the use of platinum-based chemotherapy alongside immunotherapy were associated with improved outcomes. PD-1/PD-L1 inhibitors have demonstrated promising efficacy and safety in treating lung cancer patients with brain metastases, as evidenced by significant improvements in OS, PFS, and response rates. Incorporating PD-1/PD-L1 inhibitors into the treatment regimen, particularly for patients with high PD-L1 expression, has the potential to improve clinical outcomes in this patient population.