颈淋巴结阴性鼻咽癌放疗范围的选择一个基于荟萃分析的结果

发布时间：2018-06-02 04:16

本文选题：鼻咽癌 + 颈部淋巴结转移　；参考：《苏州大学》2014年硕士论文

【摘要】：背景:鼻咽癌是我国常见的头颈部恶性肿瘤。因其特殊的解剖特点及对放射敏感的生物学特性，放射治疗已经成为其主要治疗手段。如何在不降低疗效的前提下减少放射治疗对患者造成的副反应及损伤，这个问题成为了人们研究的热点。尽量减小照射靶区是方法之一。在鼻咽癌病例中，，有20%~30%患者为颈淋巴结阴性，即N0期鼻咽癌患者。对于这部分患者的颈部预防性放疗，我国临床已达成仅行上半颈预防性照射的共识。研究目的:通过荟萃分析以往研究中行上半颈和全颈放疗的N0期鼻咽癌病例，比较其疗效，再次验证颈淋巴结阴性鼻咽癌病例的颈部放疗适宜范围的选择。方法:从Pubmed、Embase、Cochrane和万方数据库检索出1990年1月至2013年6月期间公开发表的相关文献，制定文献入组标准，筛选出符合入组标准的文献，采用固定效应模型对接受上颈和全颈放疗病例的数据进行比值比（OR）的综合分析，分析指标包括5年颈部局部控制率、颈部照射野内局部控制率和颈部照射野外局部控制率。结果:共有5篇文献符合入组标准，均属回顾性研究。5项研究共有1333例患者入组，其中970例接受上颈放疗，363例接受全颈放疗。上颈和全颈放疗的病例之间的5年全颈部局部控制率、颈部照射野内局部控制率和颈部照射野外局部控制率差异无统计学意义，OR值分别为0.89（95%CI：0.41～1.94）；1.29（95%CI：0.58～2.88）和0.42（95%CI：0.07～2.36）。结论:颈部淋巴结阴性鼻咽癌颈部放疗范围选择上颈部照射是合适的。
[Abstract]:Background: nasopharyngeal carcinoma (NPC) is a common malignant tumor of head and neck in China. Because of its special anatomical characteristics and radiosensitive biological characteristics, radiotherapy has become the main treatment method. How to reduce the side effects and injuries caused by radiotherapy without reducing the curative effect has become a hot topic. Minimizing the target area is one of the methods. 20% of NPC patients were neck lymph node negative, i.e. N 0 NPC patients. For this group of patients, we have reached a consensus that only upper half neck should be treated with prophylactic radiotherapy. Objective: to compare the efficacy of N0 stage nasopharyngeal carcinoma (NPC) treated with upper neck and full neck radiotherapy in previous studies, and to verify the choice of appropriate range of cervical radiotherapy for cervical lymph node negative nasopharyngeal carcinoma (NPC). Methods: the published literature was retrieved from the Pubmedus Embase Cochrane and Wanfang databases from January 1990 to June 2013. The fixed effect model was used to analyze the ratio of the data of upper neck and total neck radiotherapy. The analysis indexes included local control rate of neck in 5 years, local control rate in the field of neck irradiation and local control rate in field of irradiation of neck. Results: a total of 5 articles were in accordance with the admission criteria. All of them were included in a retrospective study of 5 items. 1333 patients were enrolled in the study. 970 of them received upper neck radiotherapy and 363 received total cervical radiotherapy. There was no significant difference in the local control rate between the upper neck and the whole neck radiotherapy, the local control rate in the field of neck irradiation and the local control rate in the field of neck irradiation. The OR values of the local control rates in the field of neck irradiation and in the field were 0.891.94 and 1.291.94 respectively, and the CIW of 0.4295 CI: 0.072.36, respectively. Conclusion: the range of cervical radiotherapy for cervical lymph node negative nasopharyngeal carcinoma is appropriate.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.63

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