胶质瘤放疗联合同期替莫唑胺化疗引起假性进展特点的系统评价

Radiotherapy combined with concomitant temozolomide chemotherapy causing glioma pseudo-progression:a systematic review

目的 探讨胶质瘤放疗联合同期替莫唑胺（TMZ）化疗后发生假性进展的临床特点。方法 计算机检索Cochrane Library、Bandolier、Pub Med、CNKI和维普资讯等数据库,收集1990~2014年胶质瘤放疗联合同期TMZ化疗后引起假性进展的研究、肿瘤疾病进展并描述生存分析的随机对照试验、列队研究、病例对照和回顾性病例分析研究。进行文献质量评价后对假性进展的临床特点进行归纳性描述。结果 纳入病例对照研究1项,病例分析研究1项,文献结果尚可信。胶质瘤放疗联合TMZ化疗后影像学异常疑似肿瘤进展者占总放、化疗患者的42.4%（36/85）~53.3%（24/45）,其中假性早期进展者占50.0%（18/36）~54.2%（13/24）;假性进展与手术范围有关,与放疗剂量、卡氏评分等无关,与年龄的相关性不确定;假性进展者较肿瘤进展患者的中位生存期和无进展生存期长。结论 胶质瘤放疗联合TMZ化疗后出现假性进展的可能性较高,临床上需综合考虑,尤其要结合患者临床表现。

Objective To investigate the clinical characteristics of pseudo-progression occurrence after radiotherapy combined with concomitant temozolomide （TMZ） chemotherapy in glioma. Methods The databases of Cochrane Library,Bandolier, PubMed, CNKI and VIP were retrieved by computer. The randomized controlled trials （RCT）, cohort studies, case control and retrospective case analysis studies on radiotherapy combined with concomitant TMZ chemotherapy caused pseudo-progression from 1990 to 2014 were collected. After evaluating the literature quality ,the clinical characteristics of pseudo-progression were per- formed the conclusive description. Results One case-control study and 1 case analysis study were included. The results of docu- ments could be believed. The tumor progress suspected by imaging abnormalities after radiotherapy combined with concomitant TMZ chemotherapy in glioma accounted for 42.4% （36/85）-53.3% （24/45） of total patients with radiotherapy and chemotherapy, in which the early pseudo-progression accounted for 50.0% （18/36）-54.2% （13/24） ;pseudo-progression was related with the oper- ative range and had no relation with the radiotherapeutic dose and KPS scores, its relation with the age was uncertain ; the median survival period and progression-free period in the patients with pseudo-progression were longer than those in the patients with tumor progression. Conclusion Radiotherapy combined with TMZ chemotherapy has high possibility of psudo-progression, clinic needs to comprehensively consider, especially needs to combined with the patient＇s clinical manifestations.