唑来膦酸联合放射治疗治疗恶性肿瘤骨转移的Meta分析  

Zoledronic Acid Combined with Radiotherapy for Bone Metastases of Malignant Tumor: A Meta-Analysis

作　　者：时红萍[1,2] 张秋宁[3] 刘国庆[2] 张质钢[1,2] 王道英[1,2] 刘小峰[1,2] 王小虎[1,2,3] 

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

出　　处：《中国循证医学杂志》2013年第7期858-867,共10页Chinese Journal of Evidence-based Medicine

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

摘　　要：目的系统评价唑来膦酸联合放射治疗(放疗)治疗恶性肿瘤骨转移的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library(2012年第10期)和CBM、CNKI、VIP、WanFang Data,收集唑来膦酸联合放疗治疗恶性肿瘤骨转移的随机对照试验,检索时限均为建库至2012年10月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果纳入29个RCT,共2 061例患者。Meta分析结果显示:与单纯放疗组比较,唑来膦酸联合放疗组可改善治疗结束时控制疼痛有效率[OR=3.08,95%CI(2.30,4.12),P<0.000 01]、治疗结束2周后控制疼痛有效率[OR=3.39,95%CI(2.52,4.56),P<0.000 01]、患者生活质量[OR=2.74,95%CI(1.66,4.52),P<0.000 01]和活动能力[OR=2.96,95%CI(2.16,4.05),P<0.000 01],并降低新生骨转移瘤发生率[OR=0.21,95%CI(0.10,0.45),P<0.000 1]和骨相关事件发生率[OR=0.17,95%CI(0.03,0.92),P=0.04]。在不良反应方面,唑来膦酸联合放疗组的发热[OR=11.92,95%CI(6.31,22.48),P<0.000 01]和低钙血症[OR=8.82,95%CI(1.61,48.36),P=0.01]发生率明显增多。结论与单纯放疗相比,唑来膦酸联合放疗能明显缓解骨转移性疼痛,有效提高肿瘤患者的活动能力并改善生活质量,同时能有效减少新发骨转移及骨相关事件发生。Objective To systematically evaluate the effectiveness and safety of zoledronic acid combined with radiotherapy in treating bone metastasis of malignant tumor.Methods Such databases as PubMed,EMbase,The Cochrane Library（Issue 10,2012）,CBM,CNKI,VIP and WanFang Data were searched to collect randomized clinical trials（RCTs） on bone metastasis of malignant tumor from inception to October,2012.References of included studies were also retrieved.Two reviewers independently screened studies according to exclusion and inclusion criteria,extracted data,and assessed the methodological quality.Then,meta-analysis was performed using RevMan 5.1 software.Results Twenty nine trials were included involving 2 021 patients.The results of meta-analysis showed that,compared with the radiotherapy alone group,zoledronic acid combined with radiotherapy improved the effectiveness rate of pain relieving at the end of treatment（OR=3.08,95%CI 2.30 to 4.12,P0.000 01）,the effectiveness rate of pain relieving two weeks after treatment（OR=3.39,95%CI 2.52 to 4.56,P0.000 01）,the quality of life（OR=2.74,95%CI 1.66 to 4.52,P0.000 01） and the ability of movement（OR=2.96,95%CI 2.16 to 4.05,P0.000 01）.Zoledronic acid combined with radiotherapy also reduced the incidence of new bone metastasis（OR=0.21,95%CI 0.10 to 0.45,P0.000 1） and the incidence rate of bone-related events（OR=0.17,95%CI 0.03 to 0.92,P=0.04）.The adverse reactions of zoledronic acid combined with radiotherapy such as fever（OR=11.92,95%CI 6.31 to 22.48,P0.000 01） and hypocalcaemia（OR=8.82,95%CI 1.61 to 48.36,P=0.01）,significantly increased.Conclusion Compared with radiotherapy alone,zoledronic acid combined with radiotherapy can relieve bone metastatic pain,effectively enhance patients’ ability of movement,improve quality of life,and decrease new bone metastasis and the occurrence of bone-related events.

关 键 词：放射治疗 唑来膦酸 骨转移 系统评价 META分析 随机对照试验 

分 类 号：R730.5[医药卫生—肿瘤]