预防性颅脑照射在完全缓解的小细胞肺癌中应用的系统评价

Prophylactic cranial irradiation(PCI)in patients with small cell lung cancer(SCLC)in complete remission:a systematic review

目的:系统评价预防性颅脑照射(PCI)在完全缓解(CR)的小细胞肺癌(SCLC)中应用的临床价值及最佳治疗剂量。方法:计算机检索PubMed、EMBASE、Cochrane Library和中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库、万方数据库,同时从参考文献中追溯查找。收集国内外有关的随机对照实验(RCT),评价纳入文献的方法学质量,并利用RevMan5.0软件进行Meta分析。结果:共纳入15个研究(2233例),其中13个RCT为行PCI与不行PCI(no-PCI)的对照,2个RCT为标准剂量(25Gy)与较高剂量(36Gy)的对照。Meta分析结果显示:相对于no-PCI组,PCI可提高SCLC患者的1、3、5年生存率[OR=1.51,95%CI(1.14-2.01)、OR=1.77,95%CI(1.33-2.35)、OR=1.57,95%CI(1.09-2.25)]和无瘤生存率[OR=2.43,95%CI(1.76-3.34)],降低脑转移率[OR=0.29,95%CI(0.19-0.46)]和其他转移率[OR=0.59,95%CI(0.43-0.80)],而在局部区域复发率[OR=0.89,95%CI(0.66-1.21)]方面无差异;与较高剂量组相比,标准剂量组可提高SCLC患者的1年生存率[OR=1.43,95%CI(1.07-1.92)]和1年无瘤生存率[OR=1.43,95%CI(1.05-1.95)],在改善SCLC患者的2年生存率[OR=1.23,95%CI(0.91-1.66)]、3年生存率[OR=1.29,95%CI(0.94-1.76)]、2年无瘤生存率[OR=1.22,95%CI(0.89-1.67)]、3年无瘤生存率[OR=1.22,95%CI(0.88-1.70)]方面无差异,但在1年脑转移发生率[OR=1.74,95%CI(1.16-2.60)]方面要高于较高剂量组。结论:在经化疗和放射治疗后完全缓解的SCLC患者中,PCI能提高总生存率和无瘤生存率,并能降低脑转移及其他远处转移率,可作为一种有效的预防治疗手段。较高剂量PCI组并不能显著降低脑转移总发生率和死亡率,故认为25Gy的PCI是标准治疗剂量。

Objective：To evaluate the clinical value and optimal therapeutic dose of prophylactic cranial irradiation（PCI）in patients with small cell lung cancer（SCLC）in complete remission.Methods： We searched PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature Database,China Journal Full Text Database,and Wanfang Database.All the relevant randomized controlled trials was collected,and the quality of the included trials was assessed.Meta-analyses were conducted by RevMan 5.0 software.Results： Fifteen studies were involved and 2233 patients were included.Meta-analysis showed that ： there was significant difference in 1-,2-,3-,5-year survival rates）,OR= 1.77,95%CI（1.33-2.35）,OR= 1.57,95%CI（1.09-2.25）],disease-free survival rate）],brain metastases rate 0.19-0.46）],other transfer rate between PCI group and no-PCI group.But there was no significant difference in local recurrence rate between PCI group and no-PCI group.To compared with higher-dose group,the standard-dose group can increase 1-year overall survival and 1-year disease-free survival,and 2-year overall survival,3-year overall survival,2-year disease-free survival,3-year disease-free survival had no difference between standard-dose group and high-dose group,but 1-year brain metastases rate was higher than high-dose group.Conclusion： PCI can improve the overall survival rate and disease-free survival rate,at the same time,reduce brain metastases and other transfer rate in patients with small cell lung cancer.So it can be used as a kind of small cell lung cancer prevention and treatment method.The high-dose PCI group did not significantly reduce the total brain metastases and mortality rate,so we think 25Gy PCI still should be standard treatment dose for SCLC.