外照射放疗联合腔内近距离放疗治疗食管癌的系统评价  

Systematic review of external beam radiotherapy plus brachytherapy in treatment of patients with inoperable esophageal cancer

作　　者：罗宏涛[1] 王小虎[1] 魏世鸿[1] 田金徽[2] 杨克虎[2] 

机构地区：[1]甘肃省肿瘤医院放疗科,甘肃兰州730050 [2]兰州大学循证医学中心,甘肃兰州730000

出　　处：《中华肿瘤防治杂志》2010年第20期1665-1668,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：甘肃省科技厅创新团队资助项目(098TTCA009)

摘　　要：目的:评价外照射联合腔内近距离放疗(观察组)与单纯外照射放疗(对照组)治疗食管癌的疗效和安全性。方法:通过计算机检索CBMdisc、VIP、CNKI、Cochrane Library、Pubmed和Em-base等数据库和手工检索8种主要中文肿瘤学期刊,收集有关外照射联合腔内近距离放疗与单纯外照射放疗治疗食管癌的随机和半随机对照试验。采用Rev-Man4.2.10进行统计学分析。结果:共收集到14个已发表的随机对照试验,1400例患者,方法学质量评价均为C级。Meta分析结果显示,近期有效率,1和3年生存率明显高于单纯外照射放疗,局部复发率在观察组降低,P值分别为0.03、<0.00001、0.005和0.02;两组5年生存率及远处转移率相似,P值分别为0.29和0.43;观察组放射性食管炎、出血、良性食管狭窄的发生率高于对照组,P值分别为0.04、0.002和0.03。两组食管穿孔和食管溃疡的发生率差异无统计学意义,P值分别为0.77和0.20;放射性肺炎发生率对照组高于观察组,P=0.0005。结论:与观察组相比,治疗组近期、1和3年生存率提高,局部复发降低;但远期生存率及远处转移率无改善;治疗组不良反应发生率增加。OBJECTIVE：To evaluate the efficiency and safety of external beam radiotherapy plus brachytherapy（EBR＋B） compared with external beam radiotherapy alone in the treatment of esophageal cancer.METHODS：CBMdisc,VIP,CNKI,Cochrane Library,Pubmed,Embeas etc.were searched by computer and eight major Chinese journals of oncology were searched by manual.Randomized and quasi-randomized controlled trials compared external beam radiotherapy plus brachytherapy with external beam radiotherapy alone in the treatment of esophageal cancer were included.The statistical software RevMan 4.2.10 was used.RESULTS：Fourteen published articals were included （1400 patients）,and all trails methodological quality were grade C.The results of Meta-analysis showed that：1,3-year survival rates of EBR＋B was significantly higher than that in EBR alone,while the tumor regrowth rates reduced,and the difference was significant （P values were 0.03,0.000 01,0.005 and 0.02 respectively）,but the 5-year survival rates and tumor metastasis rates in the two groups were not significant different （P values were 0.29 and 0.43 respectively）.As for the occurrence rates of radiation esophagitis,bleeding,benign esophageal stenosis in EBR＋B were higher than those to EBR,and there were significant differenct （P value were 0.04,0.002 and 0.03 respectively）,while esophageal perforation and esophageal ulcer were not significantly different between the two groups （P values were 0.77 and 0.20 respectively）.Radiation pneumonitis in EBR was higher than that in EBR＋B with a significant difference （P=0.000 5）.CONCLUSIONS：Compared with EBR alone,EBR＋B can improve short-term survival rates and reduce the toumor regrowth,but not improve long-term survival rates and reduce metastasis rates.There are more incidences of adverse reactions in EBR＋B.

关 键 词：食管肿瘤/放射疗法 近距离放射疗法/方法 Meta分析 综述文献 

分 类 号：R735.1[医药卫生—肿瘤]