肿瘤骨转移治疗的系统评价

A Systematic Review on Different Treatment Methods of Bone Metastasis from Cancers

背景与目的骨转移是晚期恶性肿瘤常见并发症之一。本研究系统评价放疗联合静脉双膦酸盐与单纯放疗治疗肿瘤骨转移的临床疗效和安全性。方法计算机检索Cochrane图书馆、PubMed、EMBASE、CBM、CNKI和VIP等数据库,手工检索相关中文期刊,查阅纳入文献的参考文献,按照Cochrane系统评价方法评价纳入研究的质量,采用RevMan5.0软件进行统计分析。结果共纳入22项研究,1585例病例。meta分析结果显示:放疗联合静脉双膦酸盐疗法在疼痛控制总有效率(RR=1.21,95%CI:1.13-1.30,P<0.001)、平均缓解时间(WMD=16.00,95%CI:10.12-21.88,P<0.001)、病灶控制率(RR=1.69,95%CI:1.43-1.99,P<0.001)和生活质量改善总有效率(RR=1.25,95%CI:1.08-1.45,P=0.003)方面优于单纯放疗。在不良反应方面,除放疗联合静脉双膦酸盐疗法发热高于单纯放疗外(RR=5.61,95%CI:3.11-10.13,P<0.001),在恶心呕吐发生率(RR=1.15,95%CI:0.62-2.13,P=0.65)和骨髓抑制发生率(RR=1.23,95%CI:0.75-2.02,P=0.40)方面差异无统计学意义。结论放疗联合静脉双膦酸盐可快速、有效并长效控制骨转移性疼痛,有效提高肿瘤患者的活动能力及生活质量。

Background and objective Skeletal metastase is one of the most common complications related to advanced cancer. The aim of this study is to analyze the effectiveness and safety of radiotherapy plus intravenous bisphosphonates versus radiotherapy alone for treating bone metastasis. Methods We searched the Cochrane Library, PubMed, EMBASE, CBM, CNKI and VIP, as well as the reference lists of reports and reviews. The quality of included trials was evaluated by the Cochrane Handbook. Data were extracted and evaluated by two reviewers independently. The Cochrane Collaboration’s RevMan 5.0 was used for data analysis. Results Twenty-two trials involving 1 585 patients were included. Compared with radiotherapy alone, radiotherapy plus intravenous bisphosphonates was more effective in total effective rate of pain relive （RR=1.21, 95%CI： 1.13-1.30, P0.001）, average abated time （WMD=16.00, 95%CI： 10.12-21.88, P0.001）, and quality of life （RR=1.25, 95%CI： 1.08-1.45, P=0.003, with significant differences. Side effects have no significant differences between the two groups except fever （RR=5.61, 95%CI： 3.11-10.13, P0.001）. Conclusion Current evidence supports more effective of radiotherapy plus intravenous bisphosphonates for bone metastases. The combine treatment is safe and effective.