后程加速超分割放射疗法治疗食管癌的Meta分析

Late course accelerated hyperfractionated radiotherapy for esophageal cancer:A meta-analysis

目的：评价后程加速超分割放疗（LCAH）治疗食管癌的临床有效性和安全性。方法：计算机检索Pub Med、Cochrane Library、EMBASE、CNKI、CBM、数字化期刊全文数据库,并辅手工检索和其它检索,检索截止日期为2013年10月。按照纳入标准,全面搜集有关LCAH与常规分割放疗（CR）治疗食管癌的随机对照试验,无论是否采用随机。按照Cochrane系统评价方法,由两位研究者独立提取资料和进行质量评价,并用Rev Man5.1软件进行统计分析。结果：共纳入12个研究,包括1458例患者。Meta分析显示：LCAH与CR相比,1年生存率（OR=2.13,95%CI：1.70-2.66,P〈0.001）、3年生存率（OR=2.28,95%CI：1.82-2.84,P〈0.001）及5年生存率（OR=2.28,95%CI：1.79-2.91,P〈0.001）差异均有统计学意义;1年局控率（OR=2.38,95%CI：1.88-3.01,P〈0.001）、3年局控率（OR=2.83,95%CI：2.26-3.53,P〈0.001）及5年局控率（OR=2.83,95%CI：2.26-3.53,P〈0.001）差异也有统计学意义;放疗副反应方面,急性放射性气管炎（OR=1.43,95%CI：1.08-1.89,P=0.01）和急性放射性食管炎（OR=1.65,95%CI：1.27-2.15,P=0.00）LACH均高于CR,二者差异均有统计学意义。局部复发率方面,二者差异有统计学意义（OR=0.49,95%CI：0.38-0.63,P〈0.001）,LACH低于CR。但总治疗失败率方面（局部复发＋远处转移）,二者差异无统计学意义（OR=0.93,95%CI：0.65-1.31,P=0.66）。结论：本研究结果显示,后程加速超分割放疗与常规分割放疗相比,明显提高了食管癌的总生存率与局控率,降低了局部复发率,同时增加了急性放射性气管炎及食管炎发生率,但不能降低远处转移的发生率。由于纳入研究质量不高,尚需设计科学、实施严谨的大样本、多中心随机对照试验进一步验证。

Objective：To evaluate clinical efficacy and safety of the late course accelerated hyperfractionated radiotherapy（LCAH） versus conventional fraction radiotherapy for esophageal squamous cell carcinoma. Methods： PubMed, Cochrane Library, Chinese Scientific Journals full-text database, the Chinese periodical full-text databases, full-text database of digitized journals, and biomedical literature database were searched for relevant literatuers. We reviewed the references from original articles to search for more studies and tracked back to the reference to collect trails in which the deadline was Oct 2013. We included the randomized controlled trials of LCAH versus CR for esophageal squamous cell carcinoma. Two investigators assessed the quality of included trials and independently extracted data by Cochrane. The RevMan 5.1 software was used for statistical analysis. Results：A total of 12 potential relevant studies involving 1458 patients were retrieved for meta-analysis. There were significant difference between LCAH and CR in 1-year survival（OR=2.13,95%CI：1.70-2.66, P〈0.00001）,3-year survival rate （OR=2.28,95% CI：1.82-2.84,P〈0.00001） and 5-year survival （OR=2.28,95% CI：1.79-2.91, P〈0.00001） . Statistical significance were found between LCAH and CR in 1-year local control rate （OR=2.38,95%CI：1.88-3.01, P〈0.00001）,3-year local control rate （OR=2.83,95%CI,：2.26-3.53 P〈0.00001 ） and 5 - year local control rate （OR=2.83,95% CI：2.26-3.53, P〈0.00001） . Acute radiation bronchitis （OR=1.43,95% CI：1.08-1.89,P=0.01）, acute radiation esophagitis incidence （OR=1.65,95% CI：1.27-2.15, P=0.0002） in LCAH was significantly higher than CR for side effect of acute radiation, but the opposite was true for local recurrence rate（OR=0.49,95%CI：0.38-0.63,P〈0.00001）. There were no significant difference between LCAH and CR in treatment failure rate （local recurrence and distant metastasis：OR=0.93,95% CI：0.65-1.31,P=0.66）. Conclusions： Compared to CR, LCAH could improve 1-year survival rate, 3-year survival rate and 5-year survival rates, local control rates, the incidence of acute radiation bronchitis and esophagitis and reduce local recurrence;meanwhile it isn＇t reduce the incidence of distance metastasis. Large and well designed multicenter randomized controlled trial will be necessary to validate clinical efficacy and safety of LCAH versus conventional fraction radiotherapy for esophageal squamous cell carcinoma.