后程加速超分割放疗协同化疗治疗食管癌的Meta分析  

Late course accelerated hyperfrationation radiotherapy plus chemotherapy for esophageal carcinoma: a Meta-analysis

作　　者：张秋宁[1] 王道英[1,2,3] 李征[2,3] 田金徽[3] 杨克虎[3] 王小虎[1] 

机构地区：[1]甘肃省肿瘤医院放疗科,甘肃兰州730050 [2]兰州大学第一临床医学院,甘肃兰州730000 [3]兰州大学循证医学中心,甘肃兰州730000

出　　处：《实用肿瘤杂志》2011年第4期406-413,共8页Journal of Practical Oncology

基　　金：重离子等射线治疗肿瘤研究科技创新团队建设计划(098TTCA009);兰州大学循证医学中心"循证医学研究生创新基金(2010LDEBM-A)"

摘　　要：目的评价后程加速超分割放疗协同化疗(LCAHR+C)治疗食管癌的临床疗效及安全性。方法计算机检索PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库、数字化期刊全文数据库,同时从参考文献中进行追溯查找。收集所有LCAHR+C与单纯后程加速超分割放射(LCAHR)治疗食管癌的随机对照试验,根据Cochrane系统评价手册5.0质量评价标准进行质量评价,使用RevMan5.0软件进行Meta分析。结果共纳入16项研究(1 556例)。Meta分析结果显示,LCAHR+C组与单纯LCAHR组比较,其1、3、5年生存率,1、2、3年局部控制率,总有效率,无瘤生存率,放射性食管炎、放射性气管炎、胃肠道反应及骨髓抑制发生率,因局部未控制或复发、局部淋巴结或远处转移及其他原因造成的死亡或治疗失败发生率的差异均有统计学意义,其OR及95%CI分别为1.58(1.25～2.01)、1.76(1.43～2.15)、1.62(1.06～2.47)、1.56(1.16～2.09)、1.58(1.21～2.05)、1.75(1.36～2.25)、2.71(1.09～6.74)、2.14(1.29～3.55)、3.87(2.31～6.48)、2.12(1.63～2.77)、4.62(3.16～6.76)、4.83(3.56～6.55)、0.63(0.50～0.80)、0.71(0.53～0.94)、1.38(0.88～2.17);而食管狭窄、肺纤维化及食管出血或穿孔发生率的差异均无统计学意义,其OR及95%CI分别为1.16(0.69～1.96)、1.09(0.63～1.89)、0.87(0.40～1.90)。结论 LCAHR+C可提高食管癌患者的近期疗效、局部控制率及长期生存率,可作为食管癌的有效治疗手段之一。Objective To evaluate the clinical efficacy and safety of late course accelerated hyperfractionation radiotherapy plus chemotherapy（LCAHR＋C） for esophageal carcinoma. Methods PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,China Journal Full Text Database,and Chinese Scientific Journals Full Text Database were electronically searched,and available references were also searched retroactively by hand.All the relevant randomized controlled trials were collected and the quality of the included trials was assessed according to Cochrane Systematic Review Handbook.Meta-analysis was conducted by RevMan 5.0 software. Results Sixteen studies were involved and 1 556 cases were included.Meta-analysis showed that there were significant differences between LCAHR＋C group and LCAHR group in 1-,3-,5-year overall survival rate,1-,2-,3-year local control rate,total effective rate,disease-free survival rate,radiation esophagitis,radiation pneumonitis,gastrointestinal reaction,myelosuppression incidence and total death or treatment failure rate resulting in local recurrence,regional lymph node or distant metastasis and other causes.The OR and 95% CI were 1.58（1.25～2.01）,1.76（1.43～2.15）,1.62（1.06～2.47）,1.56（1.16～2.09）,1.58（1.21～2.05）,1.75（1.36～2.25）,2.71（1.09～6.74）,2.14（1.29～3.55）,3.87（2.31～6.48）,2.12（1.63～2.77）,4.62（3.16～6.76）,4.83（3.56～6.55）,0.63（0.50～0.80）,0.71（0.53～0.94） and 1.38（0.88～2.17）,respectively.There were no significant differences in late complications between the two groups,including esophageal narrow,pulmonary fibrosis and esophageal bleeding or perforation.The OR value and 95% CI were 1.16（0.69～1.96）,1.09（0.63～1.89） and 0.87（0.40～1.90）,respectively. Conclusions The current evidence suggests that LCAHR＋C can improve the recent efficacy,tumor control rate and survival rate of patients with esophageal carcinoma.

关 键 词：食管肿瘤/药物疗法 食管肿瘤/放射疗法 存活率 放射疗法/方法 随机对照试验 综合疗法 

分 类 号：R735.1[医药卫生—肿瘤]