儿童髓母细胞瘤术后放疗辅助联合化疗与术后单独放疗疗效的系统评价

Effect of postoperative combined radiation therapy and adjuvant chemotherapy versus radiation therapy alone on the five-year survival in pediatric medulloblastomas: a systematic review

【目的】对儿童髓母细胞瘤术后放疗+辅助联合化疗与单独放疗的疗效进行评价。【方法】计算机检索MEDLINE、OVID、Cochrane图书馆及中国生物医学文献数据库,收集所有相关的随机对照试验,并采用Revman4.2.2进行Meta分析。【结果】共纳入3个随机对照试验。Meta分析表明,目前儿童髓母细胞瘤术后放疗+辅助联合化疗方案会引起更高的术后感染率及血液系统副反应的发生率,并不能提高5年生存率及5年无瘤生存率。【结论】与单独术后标准剂量放疗相比,儿童髓母细胞瘤术后放疗+辅助联合化疗方案会引起更高的感染几率及血液系统并发症的发生率,并不能提高5年生存率及5年无瘤生存率,但辅助联合化疗对高危患儿的影响,以及对长期存活患儿生存质量的影响和化疗的方案仍有待于进一步研究。

[Objective] To determine the effect of postoperative radiation therapy followed by adjuvant chemotherapy versus radiation therapy alone on the 5-year event-free survival probability, 5-year survival probability, toxicity and infection in pediatric medulloblastomas. [Methods] We searched MEDLINE. Ovid. Cochrane Library and CBMdisc for RCTs. Data was extracted by two reviewers using the desslts [Results] Three RCTs were found. The combined results showed that postoperative radiation therapy followed by adjuvant chemotherapy for pediatric medulloblastoma can not increase the 5-year event-free survival probability and the 5-year survival probability, with increased the hematological toxicity and in- fection rate. [Conclusions] To compare with postoperative radiation therapy alone for treatment of pediatric medulloblas- tomas, postoperative radiation therapy followed by adjuvant chemotherapy can not increase the 5-year event-free survival probability and the 5-year survival probability, with increased hematological toxicity and infection rate. However, the ef- fect of postoperative radiation therapy followed by adjuvant chemotherapy in high-risk children, on the quality of life with long - term survived children and the regimen of chemotherapy need further study.