食管癌扩大野与累及野3DRT的Meta分析

Therapeutic effects of extended-field and involved-field irradiation in three-dimensional radiotherapy in patients with esophageal cancer：a meta-analysis

目的比较食管癌3DRT选择性淋巴引流区（扩大野）照射与累及野照射的疗效、不良反应及治疗失败方式差异。方法通过计算机检索万方、CNKI、维普、中国生物医学文献数据库、PubMed、Embase和Cochrane Library等数据库，搜集有关食管癌3DRT扩大野和累及野照射比较的临床对照研究资料，采用Stata11．0软件进行分析。两组问差异采用OR及95％CI描述。结果根据纳入和排除标准，最终纳入12个包括1095例患者的临床对照研究资料。Meto分析结果显示，与累及野照射比较，扩大野照射降低了食管癌3DRT患者野外失败率（OR=3．727，P=0．007），但≥3级放射性肺炎和放射性食管炎发生率更高（0R=0．348，P=0．001；0R=0．385，P=0．000）。两组1、2、3年LC率和0s率均相似（OR=0．966，P=0．837；OR=0．946，P=0．781；OR=0．732，P=0．098和OR=0．952，P=0．756；OR=1．149，P=0．422；OR=0．768，P=0．120），DM率也相似（OR=0．986，P=0．937）。结论与累及野照射比较，食管癌3DRT扩大野照射可降低野外失败率，但Lc和0s率未见明显优势，不良反应也相应增加。

Objective To investigate the therapeutic effects, adverse effects, and patterns of failure of elective irradiation of lymphatic drainage area （extended-field） and involved-field irradiation in three- dimensional radiotherapy （3DRT） in patients with esophageal cancer via a Meta-analysis. Methods The databases Wanfang Data, CNKI, VIP, CBM, PubMed, Embase, and Cochrane Library were searched to collect the controlled clinical trials on extended-field irradiation and involved-field irradiation in 3DRT in patients with esophageal cancer. Stata 11.0 was used for data analysis. The odds ratio （OR） with 95% confidence interval was used to describe the differences between two groups. Results According to the inclusion and exclusion criteria, a total of 12 controlled clinical trials involving 1 095 patients with esophageal cancer were included in this meta-analysis. The results of the meta-analysis showed that compared with the involved-field irradiation group, the extended-field irradiation group had a significantly reduced rate of out-field failure in patients with esophageal cancer who received 3DRT （OR= 3. 727, P= 0. 007）, but showed significantly higher rates of grade ≥ 3 acute radiation pneumonitis and radiation esophagitis （ acute radiation pneumonitis： OR= 0. 348, P= 0. 001 ; radiation esophagitis ： OR= 0. 385, P= 0. 000）. The two groups had similar 1-, 2-, and 3-year local control rate and overall survival rate （local control rate：OR = 0. 966/0.946/0.732, P = 0. 837/0.781/0.098 ; overall survival rate ： OR=0.952/1. 149/0. 768, P = 0.756/0. 422/0.120）, as well as a similar distant metastasis rate （OR= 0.986, P= 0.937）. Conclusions Compared with involved-field irradiation, extended-field irradiation can reduce the rate of out-field failure in patients with esophageal cancer who receive 3DRT. However, it does not have significant advantages in local control rate and overall survival rate and has an increased incidence rate of adverse effects.