质子放疗联合同步化疗治疗食管癌安全性和疗效的系统评价和Meta分析

Efficacy and safety of proton radiotherapy combined concurrent chemotherapy for esophageal cancer:a systematic review and Meta-analysis

目的评价质子放疗联合同步化疗治疗食管癌的安全性和有效性。方法检索PubMed、Cochrane Library、Web of Science和中国生物医学文献数据库,截止时间为2017年6月,纳入质子放疗联合同步化疗食管癌的临床研究。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Meta Analyst Beta3.13及STATA 12.0进行Meta分析。结果共纳入5篇文献接受质子放疗联合同步化疗食管癌240例患者。Meta分析结果显示:2级和3级以上放射性食管炎发生率分别为45.4%、14.1%;2级和3级及以上放射性肺炎发生率分别为2.2%、1.8%;2级和3级及以上放射性心脏疾病发生率分别为6.4%、1.6%;2级和3级及以上放射性皮炎发生率分别为22.3%、5.6%;2级和3级及以上疲劳发生率分别为24.2%、7.5%;2级和3级及以上骨髓抑制发生率分别为46.6%、19%;2级和3级及以上恶心和/或呕吐发生率分别为32.2%、8%;3年总生存率、3年局控率、3年无复发生存率和完全缓解分别为60.4%、58.8%、49.6%、62.7%。结论质子放疗联合同步化疗食管癌是一种安全有效的治疗方法,但受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy and safety of the proton radiotherapy combined concurrent chemotherapy for esophageal cancer.Methods Databases including PubMed,Web of Science,Cochrane Library,China Biology Medicine disc were searched to collect clinical studies about proton radiotherapy combined concurrent chemotherapy for esophageal cancer from their inceptions to June 2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was then performed using Meta Analyst Beta 3.13 and STATA 12.0 software.Results A total of five studies were included,of which 240 cases were in the proton radiotherapy combined concurrent chemotherapy.The results of Meta-analysis showed that the incidence of grade 2 and over 3 grade of radiation esophagitis was 45.4%and 14.1%respectively,the incidence of grade 2 and over 3 grade of radiation pneumonitis was 2.2%and 1.8%respectively,the incidence of grade 2 and over 3 grade of radiation-induced heart disease was 6.4%and 1.6%respectively,the incidence of grade 2 and over 3 grade of radiodermatitis was22.3%and 5.6%respectively,the incidence of grade 2 and over 3 grade of fatigue was 24.2%and 7.5%respectively,the incidence of grade 2 and over 3 grade of myelosuppression was 46.6%and 19%respectively,the incidence of grade 2 and over 3 grade of nausea and vomiting was 32.2%and 8%respectively,the 3 years of overall survival,local control rate,relapse free survival and complete remission were 60.4%,58.8%,49.6%and 62.7%respectively.Conclusions Proton radiotherapy combined concurrent chemotherapy is considered a safe and effective treatment for esophageal cancer.Due to limited quality and quantity of the included studies,more high quality studies are needed to verify the above conclusions.