高剂量率与低剂量率近距离放射治疗宫颈癌的系统评价

High-dose rate and low-dose rate intracavitary brachytherapy for cervical carcinoma:a systematic review

目的:评价高剂量率(high dose rate,HDR)与低剂量率(low dose rate,LDR)近距离放射治疗技术对宫颈癌治疗的有效性和安全性。方法:计算机检索PubMed、EMBASE、Cochrane Library、中国生物医学文献数据库(Chinese Biomedical Literature Database,CBM)、中国期刊全文数据库(Chinese Journal Full Text Database,CJFD)和中文科技期刊全文数据库(Chinese Scientific Journals Full Text Database,CSJD),同时从参考文献中进行追溯查找,按纳入标准全面搜索相关的随机或半随机对照试验。按Cochrane系统评价的方法,采用RevMan 4.2.10软件进行Meta分析。结果:共纳入4项研究,1 253例患者。Meta分析结果显示,HDR组与LDR组相比,其3、5、10年生存率,3、5年骨盆控制率,3、5、10年无复发生存率差异均无统计学意义,相对危险度(95%的可信区间)分别为0.96(0.80～1.16)、0.92(0.83～1.01)和0.86(0.70～1.05),0.96(0.86～1.07)和0.95(0.87～1.05),1.02(0.84～1.23)、0.98(0.89～1.07)和1.02(0.88～1.19)。在复发和转移方面,其局部区域复发、局部复发联合远处转移、主动脉旁淋巴结转移和远处转移的差异也无统计学意义,相对危险度(95%的可信区间)分别为1.03(0.83～1.30)、2.23(0.78～6.34)、1.06(0.50～2.24)和1.00(0.76～1.32)。在3～5级迟发性并发症方面,膀胱、直肠乙状结肠和小肠并发症的发生率差异均无统计学意义,相对危险度(95%的可信区间)分别为1.08(0.18～6.63)、0.90(0.25～3.21)和3.12(0.96～10.15)。结论:本研究结果提示,HDR与LDR在提高宫颈癌患者生存率和肿瘤控制方面疗效相当。由于纳入研究的样本量较小且质量参差不齐,因此尚需设计科学严谨的大样本多中心随机对照试验以进一步验证。

Objective： To assess the clinical effectiveness and safety of high-dose rate （HDR） and low-dose rate （LDR） intracavitary brachytherapy for cervical carcinoma. Methods： This study retrieved relevant randomized and quasi-randomized control trial in PubMed （ 1966 to December 2007）, EMBASE （ 1974 to December 2007 ） , Cochrane Library （ Issue 4, 2007 ）, Chinese Biomedical Literature Database （CBM, 1978 to December 2007） , China Journal Full Text Database （CJFD, 1994 to December 2007）, and Chinese Scientific Journals Full Text Database （CSJD, 1989 to December 2007）. We also traced back the references to collect the relevant trails. Inclusion criteria were as follows： randomized or quasi-randomized controlled trails reported in English or Chinese; high- or lowdose rate intracavitary brachytherapy in the treatment of local advanced cervical carcinoma. Two reviewers assessed the quality of included trials and extracted data independently. The RevMan 4.2.10 software was used for Meta-analysis. Results： Four studies were involved and 1 253 patients were included. Meta-analysis showed that there was no significant difference in 3-, 5-, 10-year overall survival rate, 3- and 5-year pelvic control rate, 3-, 5-, and 10-year relapse-free survival rate between HDR group and LDR group. The pooled relative risk value and95% CI were 0. p6 （0.80-1.16）, 0.92 （0.83-1.01）, 0.86 （0.70-1.05）; 0.96 （0.86-1.07）, 0.95 （0.87- 1.05 ） ; 1.02 （0.84-1.23）, 0.98 （0.89-1.07）, and 1.02 （0.88-1.19）, respectively. There was no significant difference in localregional recurrence, local recurrence with distant metastasis, para-aortic lymph node metastasis, and distant metastasis between the two groups. The relative risk value and 95% CI were 1.03 （0.83-1.30）, 2.23 （0. 78-6.34）, 1.06 （0.50-2.24）, and 1.00 （0.76- 1.32）, respectively. The 3-5 grade complications in the bladder, rectosigmoid colon, and small intestine had no statistical difference between the two groups. The relative risk value and 95 % CI were 1.08 （0.18-6.63 ）, 0. 90 （0.25-3.21 ）, and 3.12 （ 0.96-10.15 ）, respectively. Conclusion：This study suggests that HDR has similar effects with LDR in improving the survival rate and tumor control rate of patients with cervical carcinoma. Because of the small number and uneven qualities of samples, the conclusion needs further verification by large sample, multi-center, randomized controlled trials.