全脑放疗联合替莫唑胺治疗非小细胞肺癌脑转移的荟萃分析  

Whole brain radiation therapy plus temozolomide in the treatment of brain metastases from nonsmall cell lung cancer： a meta-analysis

作　　者：廖恺[1] 毕卓菲[1] 何艳[1] 刘宜敏[1] 

机构地区：[1]中山大学孙逸仙纪念医院放疗科,广州510120

出　　处：《中华医学杂志》2012年第45期3199-3203,共5页National Medical Journal of China

摘　　要：目的通过荟萃分析，探讨全脑放疗（WBRT）联合替莫唑胺（TMZ）治疗非小细胞肺癌（NSCLC）脑转移的疗效及安全性。方法通过Medline、EMBASE、Cochrane、CBM等数据库检索国内外文献截止日期为2011年12月31日相关文献。选择治疗组为WBRT＋TMZ、对照组为单纯WBRT的NSCLC脑转移的随机对照试验（RCT）。由2位评价者分别按上述检索策略收集资料，按纳人标准人选，主要对客观缓解及不良反应进行荟萃分析，其次是总生存（OS）。结果共纳人4个RCT。WBRT＋TMZ与单纯WBRT相比，前者客观缓解率是后者的1．55倍（P=0．003）；在不良反应方面，胃肠道不良反应（恶心、呕吐）的发生率两组相当（P=0．14），而血液学不良反应（3／4度骨髓抑制）的发生率前者是后者的2．47倍（P=0．008）；在远期疗效方面，两组间生存获益的可能性相当（P=0．69）。结论现有证据提示对于NSCLC脑转移的治疗，WBRT＋TMZ与单纯WBRT相比，改善了客观缓解，但增加了血液学不良反应，未能将近期的局控获益转化为远期的生存获益。因此，对于WBRT＋TMZ治疗NSCLC脑转移的疗效和安全性，还需要进一步的大规模、高质量、前瞻性的Ⅲ期临床研究进行验证。Objective To explore the efficacy and safety of whole brain radiation therapy （WBRT） plus temozolomide （TMZ） versus WBRT alone in the treatment of brain metastases from non-small cell lung cancer （NSCLC） through a meta-analysis. Methods All previously published and some unpublished studies were comprehensively searched from the databases of MEDLINE, EMBASE, Coehrane Library and CBM, etc. The meta-analysis included all randomized controlled trials （RCTs） to compare WBRT plus TMZ with WBRT alone in treatment of brain metastases from NSCLC. The primary meta-analysis was based upon objective remission （OR） and toxicity and the second overall survival （OS）. Results Four RCTs identified by two reviewers were included. There was significant improvement for the WBRT ＋ TMZ group in OR rate （ RR = 1.55, P = 0. 003 ） ; but without significant improvement in OS （ P = 0. 69）. Meanwhile, WHO grade Ⅲ/Ⅳ hematologic toxicity of myelosuppression increased in the WBRT ＋ TMZ group （ RR = 2.47, P = 0. 008）, but without significant difference in gastrointestinal toxicity （ P = 0. 14 ）. Conclusions For the treatment of brain metastases from NSCLC, the combined therapy of WBRT plus TMZ improves OR, but without significant improvement in OS. And the incidence of myelosuppression is elevated. Future large- scale, high-quality and prospective phaseⅢ RCTs are needed to confirm the clinical efficacy and safety of WBRT olus TMZ.

关 键 词：癌 非小细胞肺 肿瘤转移 放射疗法 计算机辅助 

分 类 号：R734.2[医药卫生—肿瘤]