脑转移瘤患者行立体定向放疗与全脑放疗的Meta分析

发布时间：2018-03-07 23:16

  本文选题：脑转移瘤　切入点：全脑放射治疗　出处：《河南科技大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:中枢神经系统转移瘤(脑转移瘤)是成年人出现颅内肿瘤的最常见形式。25%-35%的恶性肿瘤可发生脑转移。根据美国国立综合癌症网络最新更新的中枢神经系统肿瘤临床实践指南中,对于中枢神经系统肿瘤的治疗,特别是对于不能手术的患者,放疗是最重要的一种治疗方式。本研究的研究目的是评价脑转移瘤患者给予全脑放射治疗或立体定向放疗或给予两者联合放疗后,对总生存期及生活质量的影响,为患者选择最佳的治疗方案提供循证学依据。方法:根据研究目的制定检索式,在各大数据库中搜索关于全脑放射治疗或立体定向放疗或两者联合放疗疗效的相关临床研究,根据纳入排除标准选择纳入文献,提取数据并采取RevMan5.0软件对研究数据进行Meta分析。结果:最终有31篇文献可纳入本研究,共24695名患者;Meta分析结果示:(1)立体定向放疗与全脑放疗相比:全脑放疗增加患者死亡风险HR=1.63(95%CI 1.34-1.99,P0.00001),而对于1-3个脑转移灶患者,两种放疗计划并无明显差别HR=1.48(95%CI 0.89-2.43,P=0.130);行全脑放疗的患者脑转移灶的局部控制率降低HR=2.06(95%CI 1.24-3.43,P=0.006);两者3级以上的放疗毒性无明显差别OR=1.84(95%CI 0.75-4.51,P=0.180)。(2)联合放疗与全脑放疗相比:联合放疗可明显提高患者的总生存期HR=0.78(95%CI 0.70-0.87,P0.0001),及1-3个脑转移瘤患者的生存期HR=0.82(95%CI 0.70-0.95,P=0.009),联合放疗提高局部控制率HR=0.30(95%CI 0.20-0.44,P0.00001);联合放疗并未增加患者的2级以上放疗相关毒副反应发生率:急性毒副反应OR=0.74(95%CI 0.45-1.21,P=0.230),晚期毒副反应OR=1.25(95%CI 0.58-2.72,P=0.570)。(3)联合放疗与立体定向放疗相比:两种放疗计划对于所有患者,及1-3个脑转移灶患者总生存期的影响并无明显差别:HR=0.96(95%CI 0.88-1.06,P=0.420),HR=0.96(95%CI 0.84-1.10,P=0.570);肿瘤控制率方面,联合放疗对局部控制率有明显优势HR=0.82(95%CI 0.69-0.97,P=0.020),而患者远处控制率及总控制率无明显差别HR=0.89(95%CI 0.72-1.09,P=0.260);而在1-3个脑转移灶的患者群中,局部控制率无明显差别:HR=1.01(95%CI 0.77-1.32,P=0.960),HR=1.09(95%CI 0.80-1.49,P=0.580);两种放疗计划的2级以上放疗毒性无明显差别OR=1.18(95%CI 0.78-1.79,P=0.440)。结论:三种放疗方案中,联合放疗对患者的总生存期及局部控制率有较明显优势,脑转移瘤的数量并不是绝对的限制条件;立体定向放疗与全脑放疗相比,立体定向放疗的优势更加突出,可明显提高患者的总生存期及局部控制率;放疗相关毒副反应方面,彼此之间并无明显差别,联合放疗并未提高放疗毒副反应。
[Abstract]:Objective: central nervous system metastasis (CNS) is the most common form of intracranial tumors in adults. In the guidelines for Clinical practice in Cancer, For the treatment of central nervous system tumors, especially for patients who cannot be operated on, Radiotherapy is one of the most important treatment methods. The purpose of this study was to evaluate the effects of whole-brain radiotherapy or stereotactic radiotherapy or combined radiotherapy on the overall survival and quality of life in patients with brain metastases. Methods: according to the objective of the study, a search formula was developed to search for the clinical studies on the effects of global brain radiotherapy or stereotactic radiotherapy or combined radiotherapy. According to the inclusion exclusion criteria, we selected the inclusion literature, extracted the data and analyzed the research data with RevMan5.0 software. Results: finally, 31 articles could be included in this study. A meta-analysis of 24695 patients showed that stereotactic radiotherapy increased the risk of death in patients with HR=1.63(95%CI 1.34-1.9ng P0.00001, compared with whole-brain radiotherapy, while in 1-3 patients with brain metastases. There was no significant difference between the two radiotherapy plans (HR=1.48(95%CI 0.89-2.43); the local control rate of brain metastases in patients undergoing whole-brain radiotherapy decreased HR=2.06(95%CI 1.24-3.43 P0.006; there was no significant difference in radiation toxicity between the two groups above grade 3 (OR=1.84(95%CI 0.75-4.51). The total survival time (HR=0.78(95%CI) of patients with brain metastases was increased significantly (HR=0.78(95%CI 0.70-0.87g P 0.0001g), the survival time of 1-3 patients with brain metastases was 0.70-0.95U P0.0009, and the local control rate of HR=0.30(95%CI 0.20-0.44mP0.00001n was improved by combined radiotherapy. The incidence of acute side effects associated with radiotherapy above grade 2 was not increased by combined radiotherapy. Side effects of OR=0.74(95%CI 0.45-1.21 OR=0.74(95%CI 0.230, late toxicity OR=1.25(95%CI 0.58-2.72PU 0.570. 3) combined radiotherapy compared with stereotactic radiotherapy: two radiotherapy plans for all patients, There was no significant difference in the overall survival time between 1-3 patients with brain metastases and those with CI 0.88-1.06Ph 0.420, CI 0.84-1.10P0.5700.The tumor control rate was significant. The local control rate of combined radiotherapy was significantly superior to that of HR=0.82(95%CI 0.69-0.97, while the distant control rate and the total control rate of the patients had no significant difference in HR=0.89(95%CI 0.72-1.09Pu 0.260, but in the patients with 1-3 brain metastases, there was no significant difference in the distance control rate and the total control rate, but in the group of 1-3 brain metastases, there was no significant difference between the two groups. There was no significant difference in local control rate between 1.01-95CI-0.77-1.32Pn0.9600.96. There was no significant difference in the toxicity of OR=1.18(95%CI 0.78-1.79 P0.440.400.Conclusion: the total survival time and local control rate of patients with combined radiotherapy were significantly superior. The number of brain metastases is not an absolute limitation. Stereotactic radiotherapy has more advantages than whole brain radiotherapy, which can significantly improve the overall survival time and local control rate of patients. There was no significant difference between the two groups, and combined radiotherapy did not increase the toxicity of radiotherapy.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4
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本文编号：1581400