早期乳腺癌保乳术后全乳腺大分割放疗与常规放疗疗效和安全性的系统评价

Efficacy and Safety of Hypofractionation Radiotherapy versus Conventional Whole Breast Radiotherapy for Early Stage Breast Cancer after Breast Conserving Surgery:A Systematic Review

目的系统评价早期乳腺癌保乳术后全乳腺大分割放疗与常规分割放疗的疗效、美容效果和不良反应。方法计算机检索CNKI、CBM、VIP(1989年至2015年5月)、Pub Med、EMbase和The Cochrane Library(2015年1期),搜集关于大分割放疗与传统常规放疗治疗早期乳腺癌保乳术患者的随机对照试验(RCT),检索时限均从建库至2015年5月。由2位研究员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果共纳6个RCT,包含8 240例患者。Meta分析结果显示,大分割放疗组与常规放疗组在肿瘤局部复发率[5年:RR=1.01,95%CI(0.73,1.40),P=0.94;10年:RR=1.04,95%CI(0.86,1.26),P=0.67]、全因死亡率[5年:RR=0.95,95%CI(0.85,1.08),P=0.45;10年:RR=0.97,95%CI(0.86,1.09),P=0.61]、乳房影像学外观改变率[RR=0.98,95%CI(0.91,1.05),P=0.56]、放疗后肺部纤维化发生率[5年:RR=1.07,95%CI(0.66,1.72),P=0.78;10年:RR=1.05,95%CI(0.62,1.77),P=0.86]、肋骨骨折发生率[5年:RR=1.00,95%CI(0.60,1.68),P=0.99;10年:RR=1.19,95%CI(0.70,2.00),P=0.52],以及缺血性心脏病发生率[5年:RR=0.88,95%CI(0.54,1.45),P=0.62;10年:RR=0.86,95%CI(0.54,1.37),P=0.53]方面差异均无统计学意义。结论早期乳腺癌保乳术后全乳腺大分割放疗具有和传统常规放疗相同的治疗效果和美容效果,但大分割放疗可缩短治疗周期,减轻患者身体和经济负担,可作为早期乳腺癌保乳术后辅助放射治疗的有效选择。

ObjectiveTo systematically evaluate the efficacy, cosmetic outcome and adverse reaction of hypofractionation radiotherapy （HRT） versus conventional radiotherapy （CRT） for early stage breast cancer after breast conserving surgery. MethodsThe databases including CNKI, CBM, VIP, PubMed, EMbase and The Cochrane Library （Issue 1, 2015） were searched from the inception to May 2015 to collect the randomized controlled trials （RCTs） related to HRT versus CRT for early stage breast cancer after breast conserving surgery. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsSix RCTs involving 8 240 patients were included. Meta-analyses results showed, there were no statistical differences between the HRT group and the CRT group in local-regional recurrence rate （5 year： RR=1.01, 95%CI 0.73 to 1.40, P=0.94; 10 year： RR=1.04, 95%CI 0.86 to 1.26, P=0.67）, mortality （5 year： RR=0.95, 95%CI 0.85 to 1.08, P=0.45; 10 year： RR=0.97, 95%CI 0.86 o 1.09, P=0.61）, photographic breast appearance （RR=0.98, 95%CI 0.91 to 1.05, P=0.56）, the incidence of lung fibrosis （5 year： RR=1.07, 95%CI 0.66 to 1.72, P=0.78; 10 year： RR=1.05, 95%CI 0.62 to 1.77, P=0.86）, the incidence of rib fracture （5 year： RR=1.00, 95%CI 0.60 to 1.68, P=0.99; 10 year： RR=1.19, 95%CI 0.70 to 2.00, P=0.52）, and the incidence of ischemic of heart （5 year： RR=0.88, 95%CI 0.54 to 1.45, P=0.62; 10 year： RR=0.86, 95%CI 0.54 to 1.37, P=0.53）. ConclusionHRT could provide similar tumor control as CRT without serious toxicity. Meanwhile HRT is superior to CRT in terms of patient convenience and costs, it should be promoted as adjuvant treatment for early stage breast cancer after breast conserving surgery.