鼻咽癌后程加速超分割放射治疗的循征医学研究

Evidence-based medical research on late course accelerated hyperfractionation radiotherapy of nasopharyngeal carcinoma

目的对发表文献进行Meta分析以评价后程加速超分割放射治疗鼻咽癌的疗效和临床价值。方法检索Medline(1985年1月至2005年12日)、Cochrane图书馆数据库(1985年1月至2005年12月)和中国生物医学文献数据库(1985年1月至2005年12月),按照纳入标准(鼻咽癌后程加速超分割放射治疗随机试验)确定文献,评价其方法学上的质量,提取有效数据。采用Egger'stest法对纳入研究的1,3年生存率及1,3年鼻咽局部控制率资料进行发表性偏倚分析,各个研究结果的异质性检验采用χ2检验,并用Stata9.0统计软件包进行统计分析。结果4个随机对照试验、488例鼻咽癌患者纳入研究,其中接受后程加速超分割放射治疗者241例,接受常规分割放射治疗者247例。1年局控率资料分析发现发表性偏倚(P=0.03),而1,3年生存率及3年鼻咽局控率资料没有发表性偏倚(P>0.05)。Meta分析显示,四个随机研究的1,3年生存率及1,3年鼻咽局部控制率结果同质性较好(P>0.05),后程加速超分割放射治疗组与常规分割放射治疗组患者的1,3年生存率及1,3年鼻咽局部控制率的差异均有显著性,合并OR值及其95%可信区间(95%CI)分别为3.113(1.232～7.867)、1.913(1.195～3.063)和5.434(1.560～18.935)、4.308(2.210～8.396)。结论与常规分割放射治疗相比,后程加速超分割放射治疗能提高鼻咽癌患者的1,3年生存率及1,3年鼻咽局部控制率。

Objective To review published literature and perform a recta-analysis for assessing the efficacy and clinical value of late course accelerated hyperfractionation radiotherapy （LCHART） of nasopharyngeal carcinoma （NPC）. Methods Medline （ 1985.1- 2005.12） ,the Coehrane Library （ 1985.1- 2005. 12） ,and Chinese Biological Medicine Database （CBM-disc） （ 1985. 1- 2005. 12）were searched. The randomized eontroUed trials （RCT） of NPC LCHART were screened and selected, their methodological quality was appraised and data were extracted from the studies. The Egger＇s test was used to analyze publication bias of 1- ,3-year overall survival and 1-,3- year control rates of nasopharynx. The heterogeneity was detected by the chi-square test. Statistical analyses were performed using STATA 9.0. Results Four randomized controlled trials involving 488 patients were included, with 241 patients in LCHART group and 247 patients in conventional radiotherapy （CRT） group. Publication bias was significant （ P = 0.03 ） in the data of 1 -year local control rate. Publication bias was not significant （P 〉0.05） in the data of 1-,3-year overall survival and 3-year nasopharynx control rate. The homogeneity of 4 randomized trials was relatively good （ P 〉 0.05 ）. Statistical differences were found in 1-,3-year overall survival and 1-,3-year nasopharynx control rates between LCHART and CRT groups,the OR （odds ratio） values and 95% confidence interval were 3. 113 （ 1. 232- 7. 867）, 1. 913 （ 1. 195-3. 063） and 5. 434 （ 1. 560-18. 935 ） ,4.308 （2. 210-8. 396 ）, respectively. Conelu. sions NPC LCHART increased 1-,3-year overall survival and 1-,3- year nasopharynx control rates as com- pared with CRT.