三维适形放疗联合替莫唑胺治疗恶性脑胶质瘤术后患者的Meta分析

Meta-analysis of treatment of malignant gliomasby three dimensional conformal radiotherapy combined with temozolomide

目的系统评价三维适形放疗联合替莫唑胺（3D-CRT/TMZ）治疗恶性脑胶质瘤术后患者的疗效及安全性。方法检索EMbase、PubMed、Cochrane、中国知网、维普数据库和中国生物医学文献服务数据库等数据库，查找3D-CRT／TMZ治疗恶性脑胶质瘤术后患者的临床随机对照试验，采用RevMan5．2．0软件进行Meta分析。结果共纳入16个研究，共1410例患者。Meta分析结果显示：与3D-CRT相比，3D-CRT／TMZ能显著提高恶性脑胶质瘤术后患者治疗的有效率[优势比（OR）=3．60，95％可信区间（CI）为2．35-5．50，P〈0．00001]、术后1年生存率（OR=3．51，95％CI为2．53～4．87，P〈0．01）、术后2年生存率（OR=3．67，95％CI为（2．61～5．16，P〈0．01）和术后3年生存率（OR=3．73，95％CI为2．44～5．71，P〈0．01）及显著延长患者中位生存时间（平均差异：5．58，95％CI为3．56～7．61，P〈0．01），但3D-CRT／TMZ不良反应的发生率明显增高（OR=1．54，95％CI为1．14～2．09，P=0．005）。结论3D-CRT/TMZ治疗恶性脑胶质瘤术后患者的有效率、生存率、中位生存时间等疗效显著优于单纯3D-CRT治疗，而不良反应方面高于单纯3D-CRT治疗，但患者一般可耐受。

Objective To systematically assess the curative effect of three dimensional conformal radiotherapy combined with temozolomide （3D-CRT/TMZ） on malignant brain gliomas and its safety. Methods The databases including EMbase, PubMed, Cochrane Library, CNKI, VIP, CBMdisc were searched to collect randomized study of 3D-CRT/TMZ compared with three dimensional conformal radiotherapy （3D-CRT） alone for the malignant brain gliomas. The data were extracted and the Meta-analysis was conducted by RevMan 5.2.0 software. Results A total of sixteen studies were acquired. Meta-analysis revealed that compared with 3D-CRT alone, 3D-CRT/ TMZ could significantly improve the overall response rates [OR=3.60, 95%CI （2.35, 5.50）, P〈0.000 01], the overall survival rates （P〈 0.000 01）, and prolong the median survival time [MD=5.58, 95% CI （3.56, 7.61）, P〈0.000 01]. But the rate Of adverse events was higher in 3D-CRT/TMZ group than that in 3D-CRT alone group [OR=1.54, 95% CI （1.14, 2.09）, P=0.005]. Conclusions The curative effect of 3D-CRT/rMZ on malignant brain gliomas is significantly better than that of 3D-CRT. However temozolomide increased the adverse events which were not so serious and could be tolerated.