Ⅱ/Ⅲ期直肠癌术前短程放疗与常规放化疗疗效的Meta分析

Preoperative short-course radiotherapy versus preoperative chemo-radiotherapy for stage Ⅱ or Ⅲ rectal cancer: a Meta-analysis

目的：对Ⅱ／Ⅲ期直肠癌术前短程放疗（short-course preoperative radio-therapy，SCRT）与术前常规放化疗（preoperative chemo-radiotherapy，CRT）临床随机对照研究进行 Meta 分析，比较两种方案疗效及毒性反应。方法通过计算机检索 Pubmed、EMbase、Cochrane Library、中国期刊全文数据库、万方数据库和中文科技期刊数据库，收集Ⅱ／Ⅲ期直肠癌术前短程放疗与术前常规放化疗临床随机对照研究的文献，采用 RevMan 5．3软件进行 Meta 分析。结果收集到两项临床随机对照研究，Meta 分析结果显示：SCRT 组 T 分期降期率低于 CRT 组（RR ＝0．64，95％CI：0．53～0．77，P ＜0．05），SCRT 组病理完全反应率低于 CRT 组（RR ＝0．06，95％CI：0．02～0．19，P ＜0．05），两方案保肛率、局部复发率、总生存率及晚期严重毒性反应发生率差异均无统计学意义。结论Ⅱ／Ⅲ期直肠癌术前常规放化疗较术前短程放疗提高了 T 分期降期及病理完全反应率。

Objective To compare the therapeutic effect and toxic reaction between preoperative short-course radiotherapy（SCRT）and preoperative chemo-radiotherapy（CRT）for stage Ⅱ or Ⅲ rectal cancer.Meth-ods Original articles were searched in the Pubmed,EMbase,Cochrane Library,China Journal Full-text Data-base,Wanfang Database and Chinese sci-tech periodical full-text database.Randomized controlled trials compa-ring preoperative short-course radiotherapy and preoperative chemo-radiotherapy for stage Ⅱ or Ⅲ rectal cancer in accordance with the inclusion and exclusion criteria were included.Data extracted from these trials were ana-lyzed by the software named as RevMan 5.3.Results A total of 2 randomized controlled trials were included. The results of Meta-analysis showed that the SCRT group is less than CRT group in T downstage rate（RR =0.64,95%CI：0.53 -0.77,P 〈0.05）,and pathological complete response rate（RR =0.06,95%CI：0.02 -0.19,P 〈0.05）.There was no significant difference in the rate of sphincter preservation,local recurrence rate, overall survival rate and severe late toxicity rate between the two groups.Conclusions As compared with pre-operative SCRT,CRT can improve the T downstage rate and complete pathologic response rate for stage Ⅱ or Ⅲrectal cancer.