高级别脑胶质瘤术后3D-CRT与替莫唑胺同步放化疗Meta分析  

Three dimensional conformal radiotherapy concurrent combined with temozolomide treatment for postoperative high grade glioma:A Meta analysis

作　　者：陈卫峰[1] 吴倩岚[2] 莫立根[1] 

机构地区：[1]广西医科大学附属肿瘤医院神经外科,广西南宁530021 [2]广西医科大学研究生学院,广西南宁530021

出　　处：《中华肿瘤防治杂志》2014年第7期543-551,共9页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西自然科学基金(2011GXNSFA018247)

摘　　要：目的：系统评价高级别胶质瘤{high grade glioma, HGG）术后三维适形放疗（three dimensional conformal radio-therapy, 3D-CRT）与替莫唑胺（temozolamide，TMZ）同步放化疗的有效性和安全性。方法：计算机检索PubMed, Co-chrane Library, EMbase, CBM, VIP, CNKI和万方数据库，收集所有相关的临床随机对照试验（randomized controlled tri-al, RCT）。由2名研究者独立进行资料提取和质量评价，采用RevMan5．1软件进行Meta分析，应用GRADE系统对证据质量分级。结果：纳入13个RCT共1309例患者。Meta分析结果显示，与单纯3D-CRT相比，3D-CRT同步联合TMZ治疗可以提高HGG患者术后的有效率（RR=1．93，95％CI：1．53～2．44，P〈0．01）及疾病控制率（RR=1．16，95％CI：1．03～1．30，P=0．01）；亦可提高6个月（RR=1．33，95％CI：1．09～1．62，P〈0．01）、12个月0S（RR=1．39，95％CI：1．25～1．54，P〈0．01）、24个月0S（RR=2．24，95％CI：1．83～2．76，P〈0．01）和36个月0S（RR=2．48，95％CI：1．63～3．76，P〈0．01）总生存率，同时也增加了胃肠道反应（RR=2．33，95％CI：1．25～4．33，P〈0．01）及血液学毒性（RR=1．72，95％cI：1．23～2．41，P〈0．01）的发生率，但均无严重性胃肠道反应及血液学毒性报道。提示，3D-CRT同步联合TMZ组优于单纯3DCRT组。GRADE系统评价结果显示，证据水平均不会高于C级。结论：3D-CRT与TMZ同步放化疗治疗术后HGG是=种有效且安全的治疗方式。基于GRADE系统的证据质量偏低，尚需要更多大样本和高质量的RCT进一步论证。OBJECTIVE： To assess the efficacy and safety of three dimensional conformal radiotherapy （3D-CRT） concurrent combined with temozolomide （TMZ） treatment for postoperative high grade glioma compared with single 3D-CRT. METHODS： Computer retrieved was conducted to search for relevant randomized controlled trials （RCTs） in the electronic databases： PubMed, The Cochrane Library, EMBASE, CBM-disc, CNKI, Wanfang Date. Two researchers as- sessed the quality of included trials and extracted data independently. The quality of included studies was critically evalua- ted and the data were analyzed using RevMan 5.1 software,and GRADE System was used to rate the level of evidence. RESULTS： A total of 13 RCTs including 1 309 patients were involved in this meta-analysis. Meta-analyses showed that： compared with the single 3D-CRT,3D-CRT concurrent combined with TMZ could increase the effective rate（RR= 1.93, 95%CI：1.53-2.44,P〈0.01）and disease control rate （RR= 1.16,95%CI： 1.03-1.30,P=0.01）. In overall survival （OS） ,the latter also could increase 6-month OS, 12-month OS, 24-monthOS, 36-month OS（RR= 1. 33,95 % CI： 1.09-1.62,P〈0.01;RR=1. 39,95XCI：1.25-1.54,P〈0.01;RR=2.24,95%CI：1.83-2.76,P%0.01;RR=2.48,95%CI： 1.63-3. 76, P〈 0. 01, respectively）. However, the latter could increase the incidence of gastrointestinal reaction and hematologic toxicity （RR=2.33,95 %CI： 1.25-4.33,P〈0.01 ;RR= 1.72,95%CI： 1.23 2.41 ,P〈0.01 ,respectively）. Based on GRADE,the level of evidence was not higher than Grade C. CONCLUSION：Three dimensional conformal radio lherapy concurrent combined with temozolomide is a safe and effective adjuvant therapy for postoperative high grade glio- ma;and based on GRADE, the level of evidence is low, it is suggested that large-scale, high quality researches on basic and clinical fields should he performed.

关 键 词：神经胶质瘤 放射疗法 适形 替莫唑胺 META分析 

分 类 号：R739.4[医药卫生—肿瘤]