热化放三联疗法治疗食管癌的Meta分析  

Hyperthermo-chemo-radiotherapy for esophageal carcinoma:a Meta-analysis

作　　者：米登海[1,2,3] 李征[1,2] 杨克虎[1,2] 曹农[2] 田金徽[1] 马彬[1] 刘雅莉[1] 

机构地区：[1]兰州大学循证医学中心,甘肃兰州730000 [2]兰州大学第一临床医学院,甘肃兰州730000 [3]甘肃省第二人民医院,甘肃兰州730000

出　　处：《实用肿瘤杂志》2013年第1期28-35,共8页Journal of Practical Oncology

基　　金：甘肃省卫生行业科研计划项目(项目编号:GSWST09-06);甘肃省自然科学研究基金项目(项目编号:1010RJZA162);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：目的评价热疗、化疗、放疗(热化放)联合治疗食管癌的疗效及安全性,为进一步的临床实践与研究提供参考。方法 计算机检索Cochrane Library、PubMed、EMBASE、Web of Science和中国生物医学文献数据库、中国学术期刊全文数据库、中文科技期刊数据库、数字化期刊全文数据库,同时辅以其他检索。收集所有比较热化放三联疗法对比二联疗法或单用疗法的随机对照试验(randomized controlled trials,RCTs)。参考Cochrane质量评价标准并结合本研究特点对纳入研究进行质量评价后,使用RevMan 5.1软件进行Meta分析。结果 共纳入10篇RCT(787例患者)。Meta分析结果显示:(1)热化放组的1、3、5、7年生存率、3年局部控制率、完全缓解率及总有效率均高于化放组,差异均有统计学意义;白细胞下降和放射性食管炎的发生率两组比较差异无统计学意义;(2)热化放组的1、3、5年生存率、3年局部控制率及总有效率均高于单放组,且复发率低于单放组,其差异均有统计学意义;白细胞下降和放射性食管炎的发生率两组比较差异无统计学意义。结论 热化放三联疗法的远期及近期疗效均优于化放疗法及单放疗法,且具有良好的安全性和可行性。但热化放三联疗法的有效性和安全性有待于大样本高质量的RCT进一步证实。Objective To evaluate the clinical efficacy and safety of hyperthermia combined with chemotherapy and radiotherapy （HCRT） for esophageal carcinoma, and to provide the reference for clinical practice and research. Methods Foreign databases as Cochrane Library,PubMed, EMBASE,Web of Science and Chinese ones as CBM, CNKI,VIP and Wanfang were searched with computer and other sources were also retrieved as supplying, such as tracing related references. All relevant randomized controlled trials （RCTs） were collected to compare HCRT and other multiple or single therapy, such as chemotherapy combined with radiotherapy （CRT） or radiotherapy alone （RT）. The quality of the included trials was assessed according to the Cochrane Handbook 5.1 for Systematic Review and the features of this study as well. Meta-analyses were conducted by using RevMan 5.1 software. Results Ten RCTs were included with 787 patients involved. Meta-analysis showed that the 1-, 3-,5-,7-year survival rate, 3-year local control rate, complete response and total effective rate of HCRT group were higher than those of CRT group; and there were significant differences. The 1-, 3-, 5-year survival rate,3-year local control rate and total effective rate of HCRT group were higher than those of RT group, the incidence of HCRT group was lower than that of RT group on the indicator of recurrence rate ; and there were significant differences on all of the indicators. There were no significant differences on the indicators of leukocytopenia and radiatiouesophagitis between the HCRT group and CRT group（ or RT group）. Conclusions Compared with the CRT or RT, HCRT can improve long-term and short-term curative effect, additionally, it is safe and feasible. But its long-term survival rate and more comprehensive security still needs to be further verified by more large sample and high quality RCTs.

关 键 词：食管肿瘤 药物疗法 放射疗法 高温 治疗性 系统分析 随机对照试验 综合分析 

分 类 号：R735.1[医药卫生—肿瘤] R73-31[医药卫生—临床医学]