不可手术局部晚期非小细胞肺癌诱导化疗后同期放化疗的Meta分析及回顾性研究

发布时间：2018-04-08 11:13

  本文选题：局部晚期非小细胞肺癌　切入点：诱导化疗　出处：《遵义医学院》2017年硕士论文

【摘要】：目的:1.通过Meta分析对比不可手术局部晚期非小细胞肺癌患者经诱导化疗后同期放化疗与同期放化疗两种治疗模式的疗效和安全性差异。2.对我院局部晚期非小细胞肺癌经诱导化疗后同期放化疗治疗模式下的近、远期疗效及治疗不良反应进行评价,了解此治疗模式优势、不足之处,探讨其临床可行性。方法:1.计算机检索The Cochrane Library、Pub Med、Embase、Web of Science、CBM、CNKI数据库,同时辅佐其他检索途径,搜集近15年有关局部晚期非小细胞肺癌诱导化疗后同期放化疗与同期放化疗治模式的随机对照试验。质量评价参考Cochrane质量评价标准,统计学分析应用Review Manager 5.2软件。2.回顾性研究2007年1月至2016年1月遵义医学院附属医院初治的52例不可手术的局部晚期非小细胞肺癌(NSCLC)患者,治疗模式均为诱导化疗加同期放化疗,放疗采用三维适形调强放疗(IMRT)。治疗结束后按照RECIST1.1标准进行评估疗效,毒副反应按照WHO毒副反应评价标准进行评价。观察患者的治疗后完全缓解(CR)、部分缓解(PR)、病情稳定(SD)、病情进展(PD)、1、2、3、5年总生存率(OS)及治疗期间不良反应情况。结果:1.Meta分析结果显示近期疗效:总有效率差异无统计学意义(OR=1.30,95%CI:0.96~1.77,P=0.10);远期疗效:1年生存率、2年生存率差异无统计学意义(OR=1.51,95%CI:0.97~2.43,P=0.07)、(OR=1.34,95%CI:1.00~1.79,P=0.05),3年生存率差异具统计学意义(OR=1.43,95%CI:1.02~2.01,P=0.04);Ⅲ~Ⅳ级毒副反应:放射性食管炎、白细胞降低差异有统计学意义(OR=1.96,95%CI:1.06~3.62,P=0.03)、(OR=1.84,95%CI:1.24~2.74,P=0.002);放射性肺炎、恶心、呕吐差异无统计学意义(OR=1.31,95%CI:0.62~2.77,P=0.48)、(OR=1.46,95%CI:0.82~2.59,P=0.19)。2.我院回顾性研究结果显示全组患者中位生存时间为24个月,1、2、3及5年OS分别为80.8%、50.8%、38.0%及9.5%。总反应率为86.5%。3-4级不良反应发中,白细胞降低者占32.7%;血小板下降2%;血红蛋白降占2%,恶心、呕吐者占5.8%;放射性食管炎占5.8%,放射性肺炎占13.5%。结论:Meta分析结果显示诱导化疗后同期放化疗虽Ⅲ~Ⅳ级毒性反应稍增多,但3年生存率疗效较同期放化疗提高,我院回顾性研究结果显示诱导化疗后同期放化疗毒性反应可接受,是安全有效的治疗手段。此治疗方法近期疗效明确,远期疗效可观,但仍需开展大样本临床试验证实。
[Abstract]:Purpose 1.Meta analysis was used to compare the efficacy and safety of two modes of radiotherapy and chemotherapy after induction chemotherapy and simultaneous radiotherapy and chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC). 2.To evaluate the near and long term curative effect and adverse reaction of local advanced non-small cell lung cancer treated with radiotherapy and chemotherapy after induction chemotherapy, to understand the advantages and disadvantages of this treatment model, and to explore its clinical feasibility.Method 1: 1.To search the The Cochrane Library The Medbase Web of CBMN CNKI database and assist other retrieval approaches, a randomized controlled trial was conducted in the past 15 years on the simultaneous radiotherapy and chemotherapy of locally advanced non-small cell lung cancer (NSCLC) after induction chemotherapy.The quality evaluation referred to Cochrane quality evaluation standard, and applied Review Manager 5.2 software. 2. 2.From January 2007 to January 2016, 52 cases of non-operative NSCLC patients with locally advanced non-small cell lung cancer (NSCLC) treated in affiliated Hospital of Zunyi Medical College were studied retrospectively. All the patients were treated by induction chemotherapy plus concurrent radiotherapy, and three dimensional conformal intensity modulated radiotherapy (IMRTT) was used for radiotherapy.The curative effect was evaluated according to RECIST1.1 standard and the side effects were evaluated according to WHO criteria after treatment.To observe the complete remission, partial remission, stable SDI, the overall 5-year survival rate and the adverse reaction during the treatment.缁撴灉:1.Meta鍒嗘瀽缁撴灉鏄剧ず杩戞湡鐤楁晥:鎬绘湁鏁堢巼宸�寮傛棤缁熻�″�︽剰涔�(OR=1.30,95%CI:0.96~1.77,P=0.10);杩滄湡鐤楁晥:1骞寸敓瀛樼巼,2骞寸敓瀛樼巼宸�寮傛棤缁熻�″�︽剰涔�(OR=1.51,95%CI:0.97~2.43,P=0.07),(OR=1.34,95%CI:1.00~1.79,P=0.05),3骞寸敓瀛樼巼宸�寮傚叿缁熻�″�︽剰涔�(OR=1.43,95%CI:1.02~2.01,P=0.04);鈪�~鈪ｇ骇姣掑壇鍙峉hould: radiation esophagitis,The results of retrospective study in our hospital showed that the median survival time of the whole group was 24 months and 5 years OS was 80.8% and 50.8%, 38.0% and 9.5%, respectively.The total reaction rate was 86.5.3-4 grade adverse reactions, the leukopenia accounted for 32.772; the platelets decreased 2; the hemoglobin decreased 2, the nausea and vomit 5.8. the radiation esophagitis accounted for 5.8and the radiation pneumonia 13.5.ConclusionThe results of meta-analysis showed that the 3-year survival rate was higher than that of chemoradiotherapy in the same period, although the toxic reactions of grade 鈪，

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