食管鳞癌精准放疗技术下累及野照射与选择性淋巴引流区照射Meta分析

发布时间：2018-01-07 07:43

  本文关键词：食管鳞癌精准放疗技术下累及野照射与选择性淋巴引流区照射Meta分析　出处：《中华肿瘤防治杂志》2017年02期 　论文类型：期刊论文

  更多相关文章： 食管肿瘤 三维适形/调强放射疗法 累及野照射 临床靶体积

【摘要】：目的进入三维适形/调强放射治疗时代,食管鳞癌患者行根治性放疗是否需要进行选择性淋巴引流区照射(elective nodal irradiation,ENI),或仅需累及野照射(involved-field irradiation,IFI)仍存在争议,因此本研究应用Meta分析方法比较食管鳞癌三维适形/调强放射治疗采用IFI与ENI的疗效和毒副作用,为临床应用提供参考。方法检索中国生物医学文献数据库、中国学术期刊全文数据库、Cochrane Library、PubMed和EMbase等国内外数据库有关食管鳞癌精准放射治疗条件下IFI与ENI对比的文献,末次检索时间2016-08-31。依据入选和排除标准,收集各项研究中有关临床疗效、毒副反应及失败模式,应用Meta分析方法比较IFI与ENI在临床治疗食管鳞癌患者中的优劣。结果初检出文献63篇,剔除学位论文/会议投稿或非北大医学图书馆收录文献18篇。进一步阅读全文,排除数据重复发表文献20篇,采用二维技术2篇以及非病例对照研究14篇,最终纳入符合标准的国内外文献9篇。共包括1 143例患者,其中采用单纯放疗605例,放化综合治疗538例。结果显示,IFI组与ENI组相比1、2和3年局部控制率差异无统计学意义(OR=0.759,95%CI为0.572~1.008,P=0.057;OR=1.076,95%CI为0.790~1.466,P=0.641;OR=0.977,95%CI为0.726~1.315,P=0.879),1、2和3年OS差异无统计学意义(HR=0.824,95%CI为0.623~1.091,P=0.959;HR=1.030,95%CI为0.715~1.483,P=0.206;HR=0.846,95%CI为0.488~1.465,P=0.551),但≥3级放射性食管炎、≥3级放射性肺炎发生率累及野组明显降低(OR=0.515,95%CI为0.341~0.778,P=0.002;OR=0.481,95%CI为0.254~0.913,P=0.025)。两组野外复发/转移率差异无统计学意义,OR=1.629,95%CI为0.708~3.747,P=0.251。结论食管鳞癌精准照射条件下IFI组局部控制率、生存率与ENI组差异无统计学意义,而重度放射性食管炎和放射性肺炎的发生率明显降低,且IFI照射并不增加野外复发/转移几率。考虑到纳入文献大多为回顾性研究,因此尚需开展大宗的前瞻性随机对照研究进行验证。
[Abstract]:Objective to enter the age of three-dimensional conformal / intensity modulated radiotherapy. Whether selective nodal irradiation is necessary for patients with esophageal squamous cell carcinoma after radical radiotherapy. It is still controversial that only involved-field irradiationsIFI should be involved. In this study, Meta analysis was used to compare the efficacy and side effects of IFI and ENI in three-dimensional conformal / intensity modulated radiotherapy for esophageal squamous cell carcinoma. Methods Chinese biomedical literature database and Chinese academic journal full-text database were searched for clinical application. PubMed, EMbase and other databases at home and abroad on esophageal squamous cell carcinoma under the conditions of accurate radiotherapy IFI and ENI comparison literature. The last retrieval time was 2016-08-31.According to the criteria of inclusion and exclusion, the clinical efficacy, toxicity and failure patterns were collected. Meta analysis was used to compare the advantages and disadvantages of IFI and ENI in the treatment of esophageal squamous cell carcinoma. 18 papers collected from academic papers / conference papers or non-Peking University medical library were excluded. Further reading of the full text and excluding data duplication published 20 articles. Two dimensional techniques and 14 non-case-control studies were used, and 9 domestic and foreign literatures were included. A total of 1,143 patients were included, of whom 605 were treated with radiotherapy alone. The results showed that there was no significant difference in the local control rate between the IFI group and the ENI group in 1 ~ 2 years and 3 years after combined radiotherapy and chemotherapeutic therapy, and there was no significant difference in the local control rate between the IFI group and the ENI group. 95 CI was 0.572U 1.008Pu 0.057; The CI of ORA 1.076 ~ 95C was 0.790 ~ 1.466p ~ (0.641); There was no significant difference between 0.977and 95CI (0.726 / 1. 315) and 3 years (P = 0.879) and 3 years (P < 0. 824). 95 CI was 0.623, 1.091, P0. 959; The CI of HRN 1.030 and 95% was 0.715 ~ 1.483C = 0.206; The CI of HRN 0.846 / 95 was 0.488U 1.465P 0.551g, but 鈮，

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