质子射线与光子射线治疗肺癌的剂量学比较:meta分析

Dosimetric Comparing between Protons Beam and Photons Beam for Lung Cancer Radiotherapy:A Meta-analysis

背景与目的由于缺乏质子治疗与传统光子治疗比较的临床随机对照研究,导致质子治疗在肺癌放疗中的应用没有充足的临床证据。本研究旨在探讨质子射线在肺癌放疗中的剂量学优势,以期为临床提供有价值的循证医学依据。方法计算机检索Cochrane Library、PubMed、EMbase、中国生物医学文献数据库、中国学术期刊全文数据库和中国科技期刊数据库,同时辅助其它检索,搜集所有比较质子射线与光子射线治疗肺癌的剂量学研究的文章,应用RevMan 5.2软件对满足条件的数据进行meta分析。结果 6篇文献纳入本次研究。质子射线与光子射线三维适形放疗(three-dimensional conformal radiotherapy,3D-CRT)技术比较,降低了双肺Dmean(MD=-4.15,95%CI:-5.56--2.74,P<0.001)及V20、V10、V5(MD=-10.92,95%CI:-13.23--8.62,P<0.001);降低了食管Dmean及心脏Dmean,差异有统计学意义。质子射线与光子射线调强放疗(intensity-modulated radiotherapy,IMRT)技术比较,V20、V10、V5在质子射线治疗组明显降低(MD=-3.70,95%CI:-5.31--2.10,P<0.001;MD=-8.86,95%CI:-10.74--6.98,P<0.001;MD=-20.13,95%CI:-27.11--13.14,P<0.001);而相比于光子射线(IMRT),质子射线治疗肺癌在食管Dmean差异无统计学意义,但心脏Dmean明显降低,差异有统计学意义。结论与目前普遍采用的光子射线(3D-CRT技术及IMRT技术)放疗相比,质子射线在治疗肺癌的剂量学方面有明显的优势,具有临床应用价值。

Background and objective The clinical evidences are not sufficient on the proton beam therapy of lung cancer for lacking of the RCTs on the comparing the proton with the photon beam in lung cancer radiotherapy. The aim of this study is to evaluate the dosimetry superiority of the proton beam and provide more valuable evidences to the clinical researches. Methods Clinical trails of dosimetric comparing between protons beam and photons beam for lung cancer radiotherapy were obtained from the Cochrane library, Pubmed, EMbase, CBM, CNKI, VIP, and Wan Fang databases. The data included in the study were evaluated and analyzed using the Cochrane Collaboration＇s RevMan 5.2 software. Results Six trails were included. Compared to photon therapy （three-dimensional conformal photon radiotherapy, 3D-CRT）, the proton therapy had a significantly lower total lung D_mean （MD=-4.15, 95%CI： -5.56--2.74, P〈0.001） and V20, V10, V5 （MD=-10.92, 95%CI： -13.23--8.62, P〈0.001）; The V20, V10, VS significantly decreased in proton therapy group. Compared to photon therapy （intensity-modulated photon radiotherapy, IMRT）, V20, V10, V5 were also significantly lowered in proton therapy group （MD=-3.70, 95%CI： -5.31--2.10, P〈0.001; MD=-8.86, 95%CI： -10.74--6.98, P〈0.001; MD=-20.13, 95%CI： -27.11--13.14, P〈0.001）; qhe esophagus D was not lowered, while the heart D decreased in proton therapy group. Conclusion Comparing to photon beam radiotherapy （3D-CRT and IMRT）, proton beam therapy is advantageous in dosimetry of the lung cancer radiotherapy and recommended for clinical applying.