同步放化疗治疗中晚期宫颈癌相关随机对照试验的系统评价

Systemic review of concurrent radiotherapy and chemotherapy in treatment of advanced cervical cancer

目的比较同步放化疗和单纯放疗治疗中晚期宫颈癌的安全性和可行性差异。方法计算机检索Cochrane图书馆(2012年第1期)、Medline、OVID、Springerlink、EMBase、中国生物医学数据库(CBMDisc)、CNKI数据库及万方数据库,手工检索相关杂志或参考文献。由两名评价员独立检索和提取资料并交叉核对,对纳入文献按Cochrane评价标准严格评价文献,纳入高质量随机对照试验(RCT)。Meta分析软件是Cochrane协作网提供的RevMan5.1.6。结果共纳入高质量的RCT试验10个,包括1378例宫颈癌患者,其同步放化疗组695例,单纯放疗组683例。Meta分析结果显示:两组间总体有效率和完全有效率差异显著(均P<0.05),但部分缓解率差异无统计学意义(P>0.05);两组间1～5年生存率均有显著统计学差异(均P<0.05);两组间毒副反应发生率均未见显著差异比较(均P>0.05)。结论现有证据表明,同步放化疗可显著改善中晚期宫颈癌患者近期及远期疗效,适合临床广泛推广。

Objective To evaluate the efficacy,safety and feasibility of concurrent chemoradiation in treatment of advanced cer- vical cancer. Methods Systematic review and meta-analysis. Data sources Cochrane Central Register of Controlled, OVID, MED- LINE, Springerlink, Medline, CBMdisc, CNKI and WanFang datebases. Two reviewers independently assessed trial quality and extrac- ted data. The Cochrane Collaboration＇s software RevMan 5.1.6 was used for meta-analysis. RESULTS： 10 trials（total of 1290 partici- pants） were included and assessed. Meta-analysis results that there were significant difference between two groups in CR and CR ＋ PR（ all P 〈0.05 ） ,but no difference was found in PR（ P 〉 0.05 ）. 1-year,3-year and 5-year survival rate in observational group were significant higher than control group（ all P 〈 0.05 ）. In addition, gastrointestinal side effects and bone marrow inhibition in observa- tional group were nothigher than control group （ all P 〉 0. 05 ）. CONCLUSION： Based on the available evidence, we recommended concurrent chemoradiation as the first clinical choice for advanced cervical cancer.