非常规分割放疗治疗鼻咽癌的系统评价

A Systematic Review:Non-Conventional Fractionated Radiotherapy for Nasopharyngeal Cancer

目的评价非常规分割放疗治疗鼻咽癌的疗效和副反应,为临床实践提供证据。方法制定严格的纳入和排除标准。全面检索CENTRAL、MEDLINE、EMBASE、CBMdisc和VIP等数据库。手工检索10种中文医学期刊。资料的提取由两位研究者完成,最后对纳入的研究进行资料合成。采用完全缓解率、总生存率、急性和晚期放射性副反应等指标评价非常规分割放疗的疗效和副反应。统计学处理采用Cochrane协作网提供的RevMan4.2.8软件计算相对危险度及其95%可信区间。结果共检索到113篇文献,经评价后24个随机对照研究包含2343例患者符合本系统评价的纳入标准,其中只有1个是高质量的研究,其余均为低质量的研究。Meta分析结果显示:(1)部分非常规分割放疗方法可提高鼻咽癌患者的完全缓解率和总生存率。(2)非常规分割放疗加化疗与常规分割放疗加化疗相比较,前者可以提高鼻咽癌患者的完全缓解率(缓解率=1.29,95%可信区间1.14～1.45)。(3)非常规分割放疗会增加急性放射性副反应的发生率,但不会增加晚期放射性副反应的发生率。结论由于例数偏少,且多数研究的质量偏低,尚不能证明非常规分割放疗可以提高鼻咽癌患者的完全缓解率和总生存率,但与同步化疗联合时,能取得更好的疗效,且并不增加急性毒性反应和晚期并发症。

Objective To evaluate the efficacy and side effect of non-conventional fractionated radiotherapy for nasopharyngeal carcinoma. Method Trials were identified by searching for CENTRAL, MEDLINE database, EMBASE database, Chinese Biological Medicine Database （CBMdisc） and Chinese VIP Database. We hand searched the data from 10 kinds of major Chinese journals. Two reviewers assessed and extracted the studies. The following primary outcomes were assessed： CR, OS, acute side effect and late side effect. Results 24 trials involving 2 343 patients were included. One trial was of good quality, and the rest were of poor quality. Meta-analysis of these trials showed that： （1）Only part of non-conventional fractionated radiotherapy can improve CR and OS of nasopharyngeal carcinoma. （2）Non-conventional fractionated radiotherapy combined with concurrent chemotherapy can improve the CR of nasopharyngeal carcinoma when compared with conventional one （RR=1.29,95%CI 1.14-1.45）. （3）Non-conventional fractionated radiotherapy can increase the acute side effect, but not the late radiation complication. Conclusions： It can not be concluded that non-conventional fractionated radiotherapy can improve the CR and OS of nasopharyngeal carcinoma because the number of patients was not enough and most studies were of poor quality, but it would get better effect when combined with concurrent chemotherapy, and not increase acute or late side effects.