替莫唑胺联合全脑放疗治疗恶性肿瘤脑转移的Meta分析  

Temozolomide combined with whole brain radiotherapy for brain metastasis of malignant tumors:A meta-analysis

作　　者：汪彬彬[1] 张秋宁[2] 田金徽[3] 刘锐锋[2] 王小虎[2] 

机构地区：[1]甘肃中医学院中西医结合学院,甘肃兰州730000 [2]甘肃省肿瘤医院放疗科,甘肃兰州730050 [3]兰州大学循证医学中心,甘肃兰州730000

出　　处：《实用肿瘤杂志》2014年第6期564-570,共7页Journal of Practical Oncology

摘　　要：目的系统评价替莫唑胺联合全脑放疗与单纯全脑放疗治疗恶性肿瘤脑转移的疗效和安全性。方法计算机检索Pub Med、The Cochrane Library、Web of Knowledge、中国生物医学文献数据库、中国知网和万方数据库等,收集替莫唑胺联合全脑放疗与单纯全脑放疗治疗恶性肿瘤脑转移的随机对照试验（RCT）,检索时限均从建库至2014年3月1日,并追溯纳入研究的参考文献。由2名研究者按照纳入排除标准独立筛选文献、提取资料和质量评价后,采用Rev Man 5.2软件进行Meta分析。结果纳入10个RCT,共584例患者。Meta分析结果显示,与单纯全脑放疗比较,替莫唑胺联合全脑放疗可以提高恶性肿瘤脑转移的近期疗效（OR=4.27,95%CI：2.67~6.83,P〈0.00001）,但消化道反应较严重（OR=1.78,95%CI：1.11~2.85,P=0.02）,差异有统计学意义,在头痛（OR=1.34,95%CI：0.82~2.18,P=0.24）、白细胞（OR=1.41,95%CI：0.81~2.44,P=0.22）和血小板下降（OR=2.26,95%CI：0.82~6.20,P=0.11）方面的差异无统计学意义。结论与单纯全脑放疗比较,替莫唑胺联合全脑放疗可显著提高恶性肿瘤脑转移患者近期疗效,但同时加重消化道反应,临床应用时需结合患者具体情况进行选择。Objective To systematically evaluate the efficacy and safety of temozolomide combined with whole brain radiotherapy for brain metastasis of malignant tumors.Methods Pub Med,The Cochrane Library,Web of Knowledge,CBM,CNKI and Wan Fang databases were searched to collect randomized clinical trials（RCTs） on brain metastasis of malignant tumors treated with temozolomide plus whole brain radiotherapy vs whole brain radiotherapy alone from inception to March 1st,2014.References of included studies were also retrieved.Two reviewers independently screened studies according to exclusion and inclusion criteria,extracted data and assessed methodological quality.Meta-analysis was performed using Rev Man 5.2 software.Results Ten trials were included involving 584 patients.The results of metaanalysis showed that compared with radiotherapy alone group,temozolomide combined with radiotherapy improved short-term effects（OR = 4.27,95% CI：2.67 ~ 6.83,P 〈 0.00001）,yet it increased the incidence of gastrointestinal reactions（OR =1.78,95% CI：1.11 ~ 2.85,P = 0.02）.No significant difference was observed in the incidences of headache（OR = 1.34,95% CI：0.82 ~ 2.18,P = 0.24）,white blood cell decline（OR = 1.41,95% CI：0.81 ~ 2.44,P = 0.22） and platelet decline（OR = 2.26,95% CI：0.82 ~ 6.20,P = 0.11） between two groups.Conclusion Compared with whole brain radiotherapy alone,temozolomide combined with whole brain radiotherapy can improve clinical efficacy for brain metastasis of malignant tumor.

关 键 词：脑肿瘤/放射疗法 脑肿瘤/药物疗法 脑肿瘤/继发性 达卡巴嗪/治疗应用 肿瘤转移/放射疗法 肿瘤转移/药物疗法 综合疗法 META分析 

分 类 号：R739.41[医药卫生—肿瘤] R730.55[医药卫生—临床医学]