螺旋断层放疗与调强放疗在宫颈癌中剂量学及安全性对比的Meta分析  

Meta⁃analysis on dosimetric and toxicity comparison between tomotherapy and intensity⁃modulated radiotherapy for cervical cancer

作　　者：高毓 陈敏[1] 向清明[1] 江换钢[1] 邱惠[1] 周福祥[1] GAO Yu;CHEN Min;XIANG Qingming;JIANG Huangang;QIU Hui;ZHOU Fuxiang(Dept.of Radiation and Medical Oncology,Zhongnan Hospital of Wuhan University&Hubei Oncology Clinical Research Center,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院放化疗科/湖北省肿瘤医学临床研究中心,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2023年第7期833-840,共8页Medical Journal of Wuhan University

摘　　要：目的:对比螺旋断层放疗(TOMO)与调强放疗(IMRT)在宫颈癌中剂量学及安全性的差异,为临床提供循证依据。方法:在CNKI、万方、维普、中国生物医学文献数据库、Pubmed、Embase、Web of Science、Cochrane Library中检索比较宫颈癌患者螺旋断层放疗和调强放疗的研究。2名研究者筛选文献,对纳入研究进行评估、提取数据,并使用Revman 5.4、STATA 15.0对收集数据进行Meta分析。结果:对纳入的15项研究共553个病例进行剂量学参数的分析。与IMRT相比,TOMO的计划肿瘤靶区(PTV)的适形性、均匀性更好(P<0.05);小肠V40及Dmax降低(P<0.01);直肠V30、V40、Dmean降低(P<0.05);膀胱V30、V40、Dmean降低(P<0.05)。安全性分析纳入6项研究共945人,结果提示TOMO可以减少急性胃肠道、泌尿道不良反应及远期毒性(均P<0.05),血液学毒性无明显降低。结论:宫颈癌放疗中,TOMO较IMRT靶区适形程度、均匀性更好,对危及器官保护更佳,急性胃肠道和泌尿道不良反应及远期毒性的发生率更低。Objective:To compare the differences in dosimetric parameters and toxicity between tomothera⁃py(TOMO)and intensity⁃modulated radiotherapy(IMRT)for cervical cancer and provide more evi⁃dence to the clinical practice.Methods:Studies comparing TOMO and IMRT in cervical cancer pa⁃tients were searched in CNKI,Wanfang,VIP,the Chinese Biomedical Literature Database,Pubmed,Embase,Web of Science,and Cochrane Library.Two investigators screened the litera⁃ture,evaluated the included studies,extracted data,and performed Meta⁃analysis using Revman 5.4 and STATA 15.0.Results:The dosimetric parameters analysis included 15 studies and 553 cases.Compared with IMRT,TOMO improved the homogeneity and conformity in PTV(P<0.05),less small bowel V40 and Dmax(P<0.01);less rectal V30,V40,and Dmean(P<0.05),and lower blad⁃der V30,V40,and Dmean(P<0.05).Toxicity analysis included 6 studies and 945 participants.TOMO showed reduced acute adverse effect and long⁃term toxicity(all P<0.05),but no significant reduction was found in hematological toxicity.Conclusion:TOMO has better conformity and homo⁃geneity of dose distribution and better protection of organs at risk than IMRT in radiotherapy for cervi⁃cal cancer.

关 键 词：宫颈癌 螺旋断层放疗 调强放疗 META分析 

分 类 号：R737[医药卫生—肿瘤]