非小细胞肺癌脑转移全脑放疗联合靶向药物治疗系统评价  

Combining whole brain radiotherapy with target drug for non-small cell lung cancer with multiple brain metastases:a systematic review

作　　者：秦虹[1] 张科乾[1] 李文花[1] 郝丽君[1] 阮志华[1] 

机构地区：[1]第三军医大学西南医院肿瘤科,重庆400038

出　　处：《中华肿瘤防治杂志》2015年第4期300-304,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的 通过系统评价的方法,比较全脑放疗（whole brain radiotherapy,WBRT）联合靶向治疗与单用WBRT治疗非小细胞肺癌（non-small cell lung cancer,NSCLC）伴多发脑转移患者的疗效与安全性.方法 检索PubMed、Embase、The Cochrane Library、Web of knowledge、中国生物医学文献数据库（CBM）、中国学术期刊网络出版总库（CNKI）、中文科技期刊数据库（VIP）及万方数据库,检索时间为各数据库建库时间至2014-01-04,检索有关NSCLC伴多发脑转移使用WBRT与靶向药物治疗的所有文献,通过Cochrane系统评价的方法,依次进行文献筛选、评价和数据提取,采用RevMan 5.2软件进行数据分析.结果 纳入4篇研究,共332例患者.WBRT联合靶向治疗（试验组）与单用WBRT（对照组）相比,其疾病缓解率（OR=2.50,95％CI为1.21～5.16,P=0.01）、疾病控制率（OR=2.82,95％CI为1.43～5.57,P=0.003）、中枢神经系统缓解率（OR=5.95,95％CI为1.07～33.13,P=0.04）及中位生存时间（HR=0.67,95％CI为0.50～0.91,P=0.009）差异均有统计学意义;安全性方面,试验组较易出现皮疹（OR=8.50,95％CI为1.14～63.15,P=0.04）与腹泻（OR=4.51,95％CI为1.47～13.84,P=0.008）,但均属于1～2级不良反应,可耐受,其余血液学毒性（OR=0.36,95％CI为0.02～5.88,P=0.47）、恶心呕吐（OR=1.15,95％CI为0.04～30.63,P=0.93）、乏力（OR=0.78,95％CI为0.29～2.09,P=0.62）及总毒性反应（OR=1.77,95％CI为0.67～4.68,P=0.25）差异无统计学意义.结论 WBRT联合靶向药物治疗晚期NSCLC伴多发脑转移的疗效好,不良反应可耐受,但仍需更多高质量的随机对照试验进一步验证.OBJECTIVE To compare the efficacy and safety between whole brain radiotherapy （WBRT） combined with targeted therapy （treatment group） and WBRT alone （control group） in treatment of non-small cell lung cancer （NSCLC） with hrain metastases. METHODS Search PubMed, Embase, The Cochrane Library, Web of knowledge, sinoMed, China Academic Journal Network Publishing Database,Chinese sci-tech periodical database and Wan-fang database which related WBRT plus target therapy or WBRT alone in the treatment of NSCLC with brain metastases until January 4,2014. Followed by literature assessment, data collection and extraction according to Cochrane handbook for systematic reviews. The data analysis were performed by RevMan software. RESULTS Four studies involving 332 cases were included. Results showed that compared with control group, treatment group showed higher effective rate（OR= 2.50,95% CI：1. 21-5.16, P= 0.01）, disease control rate （OR = 2. 82,95% CI： 1.43 - 5. 57, P = 0. 003）, intracranial disease control rate （OR = 5. 95, 95% CI：1.07-33.13,P=0.04） and a longer median survival time （HR=0. 67,95%CI：0. 50-0.91,P=0. 009）. In safety part,add targeted therapy are frequently had rash （OR= 8. 50,95GCI： 1. 14-63.15,P=0. 04） and diarrhea （OR= 4. 51, 95%CI： 1.47-13.84, P= 0. 008）, but both of them were 1-2 grade toxicity. There were no significant differences in Hematologic toxicity （OR=0.36,95GCI：0.02-5.88,P=0.47） ,Nausea/vomiting （OR= 1.15,95% CI：0.04-30.63,P=0.93） ,Fatigue （OR=0.78,95%CI：0.29-2.09,P=0.62） and total adverse event （OR= 1.77,95% CI：0.67-4.68,P=0.25）. CONCLUSIONS WBRT plus targeted therapy is superior to WBRT alone and well tolerated in the treatment of patients with multiple brain metastases from NSCLC. In addition,more high quality randomized controlled trials are needed.

关 键 词：非小细胞肺癌 NSCLC 脑转移 全脑放疗 靶向治疗 系统评价 

分 类 号：R734.2[医药卫生—肿瘤]