非常规分割放疗治疗头颈部肿瘤的系统评价

Non-Conventional Fractionated Radiotherapy for Head and Neck Cancer: A Systematic Review

目的系统评价非常规分割放疗治疗头颈部肿瘤的疗效和副反应,为临床实践提供证据。方法计算机检索CENTRAL、MEDLINE、EMbase、CBMdisc和VIP数据库,并手工检索10种中文医学期刊,纳入非常规分割放疗与常规分割放疗比较,或非常规分割放疗+同步化疗与单纯非常规分割放疗比较治疗头颈部肿瘤的随机对照试验(RCT)。由两位研究者进行资料提取和质量评价,并采用RevMan4.2.8软件进行Meta分析。结果共检索到551篇文献,最终纳入23个RCT,包含8411例患者。其中13个是高质量研究,其余为低质量研究。Meta分析结果显示:①非常规分割放疗与常规分割放疗比较,仅分段加速超分割放疗(S-HART)与连续加速放疗(CAIR)组的完全缓解率较高,其RR分别为1.21[95%CI(1.02,1.44)]和3.31[95%CI(1.03,1.57)];随访2年时,仅超分割放疗(HRT)可提高2年总生存率[RR=1.32,95%CI(1.13,1.54)];随访5年时,总生存率差异无统计学意义;大多数非常规分割放疗会增加急性放射性副反应的发生率,但均不会增加晚期放射性副反应的发生率;②非常规分割放疗+同步化疗与单纯非常规分割放疗比较,仅连续超分割放疗(C-HRT)组的完全缓解率较高[RR=1.58,95%CI(1.18,2.11)];随访2年时,非常规分割放疗+同步化疗组提高了2年总生存率[RR=1.35,95%C(I1.18,1.54)];随访5年时,仅C-HRT组提高5年总生存率[RR=1.57,95%CI(1.19,2.07)];两组急性和晚期放射性副反应的发生率差异均无统计学意义。结论本系统评价由于例数偏少,尚不能证明非常规分割放疗可以提高头颈部肿瘤患者的完全缓解率和总生存率;但与同步化疗联合时,可以在不增加急性和晚期放疗并发症的同时取得更好的疗效,其中HRT和C-HRT的作用尤其值得关注。

Objective To evaluate the efficacy and side effect of non-conventional fractionated radiotherapy for head and neck cancer. Methods Trials were identified by searching CENTRAL, MEDLINE, EMBASE, Chinese Biological Medicine Database （CBMdisc） and Chinese VIPDatabase. We handresearched the data from 10 kinds of important Chinese journals. Two reviewers assessed and extracted the studies. The following primary outcomes were assessed： complete relief （CR）, overall survival （OS）, acute side effect and late side effect. Results Twenty-three trials involving 8 411 patients were included. Thirteen trials were of good quality, and the rest were of poor quality. Meta-analysis of these trials showed that： （1） non-conventional fractionated radiotherapy vs conventional fractionated radiotherapy： ① Only S-HART and CAIR resulted in higher CR, RR=1.21 （95% CI 1.02 to 1.44）, 3.31 （95%CI 1.16 to 9.42）, respectively; ② Only HRT could improve 2-year OS （RR=1.32, 95%CI 1.13 to 1.54）, but this difference wasn＇t found in 5-year follow up; ③ Most of the non-conventional fractionated radiotherapy could increase acute side effects, but not the late ones; （2） non-conventional fractionated radiotherapy combined with concurrent chemotherapy vs non-conventional fractionated radiotherapy： ① Only C-HRT resulted in higher CR （RR=1.58, 95%CI 1.18 to 2.11）;② Higher 2-year OS could be gained when combined with chemotherapy （RR=1.35, 95%CI 1.18 to 1.54）, and only C-HRT resulted in higher 5-year OS （RR=1.57, 95%CI 1.19 to 2.07）. ③ Acute and late side effects of radiotherapy would not increase when combined withchemotherapy. Conclusion It can not be concluded that non-conventional fractionated radiotherapy can improve the CR and OS of head and neck cancer, for a small number of patients, but it will get effect when combined with concurrent chemotherapy, and would not increase acute or late side effects. The effects of HRT and C-HRT should be cared specially.