三维适形放疗联合替莫唑胺化疗治疗脑恶性胶质细胞瘤疗效及安全性的Meta分析  

Three- dimensional Conformal Radiotherapy Combined with Temozolomide for Brain Malignant Glioma: A Meta Analysis

作　　者：李建民[1] 

机构地区：[1]河北联合大学附属医院神经外科,河北省唐山市063000

出　　处：《中国全科医学》2013年第33期3944-3950,共7页Chinese General Practice

基　　金：河北省科技重点学科课题(10276112D)

摘　　要：目的通过Meta分析系统评价三维适形放疗联合替莫唑胺化疗治疗脑恶性胶质细胞瘤的疗效及安全性。方法计算机检索中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、中国学术期刊全文数据库(CNKI)和万方数字化期刊全文数据库,查找国内所有有关三维适形放疗联合替莫唑胺化疗与单用三维适形放疗治疗脑恶性胶质细胞瘤的临床对照试验的文献,制定纳入和排除标准。采用RevMan 5.0统计软件进行Meta分析。结果最终纳入10篇临床对照试验文献,共472例患者,242例患者纳入试验组,230例患者纳入对照组。Meta分析结果显示:无明显发表偏倚,本研究结论较为可靠。与单用三维适形放疗相比,三维适形放疗联合替莫唑胺化疗可明显提高脑恶性胶质细胞瘤患者的临床缓解率和1、2、3年生存率,延长其中位生存时间,合并OR值分别为4.20〔95%CI(2.72,6.50),P<0.000 01〕、3.34〔95%CI(2.15,5.18),P<0.000 01〕、2.56〔95%CI(1.58,4.14),P=0.000 1〕、2.81〔95%CI(1.61,4.90),P=0.000 3〕、8.42〔95%CI(7.54,9.29),P<0.000 01〕;但也增加了消化系统不良反应发生率,合并OR值为2.15〔95%CI(1.02,4.54),P=0.04〕,而血液系统、脑水肿、神经系统远期不良反应发生率两组间差异无统计学意义,合并OR值分别为1.68〔95%CI(0.92,3.08),P=0.09〕、1.19〔95%CI(0.61,2.32),P=0.61〕和1.81〔95%CI(0.90,3.65),P=0.10〕。结论国内应用三维适形放疗联合替莫唑胺化疗治疗脑恶性胶质细胞瘤有效,优于单纯的放射治疗。Objective To assess the effectiveness and safety of three - dimensional conformal radiotherapy combined with temozolomicle （TMZ） in treatment of brain malignant glioma. Methods Computer retrieving was conducted to search for rel- evant clinical controlled trails in Chinese Scientific Journals Full - text Database （ VIP）, Chinese Biomedical Literature Database （CBM）, China Academic Journal Full -text Database （CNKI） and Wanfang Digitized text Database. Two researchers assessed the quality of included trials and extracted data. The data were analyzed by using the Cochrane Collaboration＇s RevMan 5.0 soft- ware. Results A total of ten clinical controlled trails including 472 patients （242 in the trial group and 230 in the control group） were involved. The results of meta - analysis showed that there was no significant publication bias and the research conclusions were more reliable. Compared with three - dimensional conformal radiotherapy alone, the radiotherapy combined with TMZ could raise the clinical remission rate （CRR） [ OR =4. 20, 95% CI （2. 72, 6. 50）, P 〈0. 000 01], the survival rate for 1 year [ OR =3.34, 95%CI （2. 15, 5.18）, P〈0. O0001]~, for2 years [OR =2.56, 95%CI （1.58, 4.14）, P=0.000 1], for3 years [ OR = 2. 81, 95% CI （ 1.61, 4. 90 ）, P = 0. 000 3 ], and prolong the median survival time [ SMD = 8.42, 95% C1 （7.54, 9. 29）, P 〈0. 000 01 ] ; However, it also increased the incidence of digestive system adverse reactions [ OR = 2. 15, 95% C1 （ 1.02, 4. 54）, P = 0. 04 ] in patients with brain malignant glioma. There was no significant difference in the incidence of adverse reactions of blood system [ OR = 1.68, 95% CI （0. 92, 3.08）, P = 0. 09 ], cerebral edema [ OR = 1.19, 95% CI （0.61, 2.32）, P=0.61], and nervous system [OR=1.81, 95%CI （0.90, 3.65）, P=0.10] .Conclusion The three - dimensional conformal radiotherapy combined with TMZ was effective for brain malignant glioma, and it was better than radia- tion therapy alone.

关 键 词：神经胶质瘤 三维适形放疗 替莫唑胺 治疗结果 不良反应 META分析 

分 类 号：R739.4[医药卫生—肿瘤]