鼻咽癌热疗疗效的系统评价  

A systematic review:hyperthermia for nasopharyngeal carcinoma

作　　者：马姗姗[1] 王仁生[1] 肖帅[1] 戴刚毅[1] 

机构地区：[1]广西医科大学第一附属医院放射治疗科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2011年第4期288-291,共4页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西医疗卫生重点科研课题资助项目(重200626)

摘　　要：目的：评价热疗用于鼻咽癌治疗的安全性和有效性。方法：计算机检索CENTRAL、OVID-Medline、Embase、CBM、CNKI、VIP数据库,检索年限均从1985-09-2009-09。手工检索相关中文期刊。筛选合格的随机对照试验,并与作者获得联系,讨论确认相关内容后,进行质量评价,最后对纳入的研究进行资料合成。采用原发灶完全缓解率、颈部淋巴结完全缓解率、总生存率以及毒副反应等指标评价热疗的疗效和副反应。统计学处理采用Cochrane协作网提供的RevMan4.2.10.0软件计算相对危险度及其95%可信区间（CI）。结果：共检索到560篇文献,经筛选及评价后6个前瞻性随机对照研究包含381例患者被纳入。Meta分析结果显示：1）热放联合治疗与单纯放疗相比,能提高肿瘤原发灶的完全缓解率（RR=1.63,95%CI=1.23~2.16,P=0.000 6）以及颈部淋巴结的完全缓解率（RR=1.23,95%CI=1.07~1.41,P=0.004）,并不增加毒副反应的发生（RR=1.15,95%CI=0.83~1.59,P=0.39）;2）在1年总生存率上两者差异无统计学意义（RR=1.03,95%CI=0.95~1.11,P=0.49）;3）热疗联合同期放化疗与同期放化疗在颈部淋巴结的完全缓解率上差异无统计学意义（RR=1.36,95%CI=0.99~1.86,P=0.06）。结论：热疗用于鼻咽癌的辅助治疗,不增加皮肤及黏膜副反应的发生,能部分提高鼻咽癌原发灶及颈部淋巴结的缓解率,安全有效。但由于例数偏少,且多数研究的质量偏低,尚不能证明热疗可以提高鼻咽癌的1年、3年及5年总生存率,要获得更为明确的循证医学证据,还有待高质量的随机对照研究资料的积累。OBJECTIVE：To evaluate the safety and effect of hyperthermia for nasopharyngeal carcinoma.METHODS： Trials were identified by searching for CENTRAL,OVID-Medline database,Embase database,Chinese Biological Medicine Database（CBMdisc）,China National Knowledge Infrastructure（CNKI） and Chinese VIP Database with computer from 09-1985 to 09-2009.The data from kinds of major Chinese medical journals was searched as a supplement,extracted the studies and integrated them.The following outcomes were assessed： CR of primary focus,CR of cervical focus,OS and side effect.RevMan 4.2.10.0 was used to statistic for RR and 95%CI.RESULTS： Six trials with 381 patients were included from 560 papers.Meta-analysis of these trials showed that： 1）Radiotherapy combined with hyperthermia could improve CR of primary focus（RR=1.63,95%CI=1.23~2.16,P=0.000 6） and cervical focus（RR=1.23,95%CI=1.07~1.41,P=0.004）,without increaseing the side effect when compared with radiotherapy alone.2）There was no statistic difference between two treatments on the OS at one year（RR=1.03,95%CI=0.95~1.11,P=0.49）.3）Hyperthermia combined with chemoradiation can not improve CR of cervical focus when compared with chemoradiation（RR=1.36,95%CI=0.99~1.86,P=0.06）.CONCLUSIONS： Hyperthermia can improve the local control rate of primary focus and cervical focus,and do not increase the complications.It＇s safe and effective.But because the number and quality of researchers are not good enough,it can＇t prove whether this treatment improve the 1,3 and 5 years OS.More good RCTs were needed to provid the accuracy evidence of the EBM.

关 键 词：鼻咽肿瘤/放射疗法 高温 诱发 疗效评价 回顾性研究 

分 类 号：R739.63[医药卫生—肿瘤]