胶质母细胞瘤放疗结合替莫唑胺治疗对比单独放疗的Meta分析

Meta analysis on comparison between radiotherapy combined with temozolomide and single radiotherapy in glioblastoma

目的评价胶质母细胞瘤患者放疗结合替莫唑胺治疗方案的有效性和安全性。方法按Cochrane系统评价方法,分别检索Pubmed、Cochrane library、Medline、OVID数据库,对纳入的文献进行质量评估,提取数据后进行Meta分析。结果纳入的研究中替莫唑胺组对比单独放疗组汇总显示:12个月总生存率[RR1.22,95%CI(1.01,1.47),P=0.04]、24个月总生存率[RR2.65,95%CI(1.86,3.78),P<0.01],差异均有统计学意义。12个月无进展生存率[RR2.59,95%CI(1.53~4.40),P=0.000 4]、24个月无进展生存率[RR6.77,95%CI(2.82~16.26),P<0.01],差异也有统计学意义。血液毒性反应:替莫唑胺组中同步治疗期对比放疗期[RR3.21,95%CI(1.89,5.46),P<0.01];替莫唑胺组中辅助治疗期对比放疗组[RR6.11,95%CI(3.70,10.09),P<0.01];替莫唑胺组中同步治疗期对比辅助治疗期[RR0.48,95%CI(0.36,0.65),P<0.01],差异均有统计学意义;非血液毒性反应事件[RR1.11,95%CI(0.72,1.70),P=0.64],差异无统计学意义。结论放疗结合同步和随后辅助替莫唑胺治疗提高了胶质母细胞瘤患者的总生存期和无进展生存期,较高血液毒性反应发生率与替莫唑胺治疗药物相关。

Objective To evaluate the efficacy and safety of radiotherapy combined with concurrent and then adjuvant temo- zolomide in the patient with glioblastoma. Methods The databases of PubMed,Cochrane library,Medline and OVID were retrieved according to the Cochrane systematical assessment method. The included literatures were performed the quality evaluation and the meta analysis was performed after extracting the data. Results The summary of comparison between temozolomide group and radiotherapy group in the included studies showed that the 12-month overall survival rate[RR 1.22,95 %CI（1. 01,1. 47）, P= 0.04] and 24-month overall survival rate[RR 2.65,95 % CI（1.53,4.40）, P〈0. 01] had statistically significant differences ; the 12-month pregrossion free survival rate[RR 2.59,95 %CI（1. 53,4. 40）, P=0. 000 4] and 24-month pregrossion free survival rate[RR 6.77, 95%CI（2.82,16.26） ,P〈0. 01]also showed statistically significant difference. The results of adverse reaction events revealed that the hematological toxic reactions in the temozolomide group had statistical difference between the concurrent therapy period and ra- diotherapy period [RR 3.21,95 % CI （1.89,5.46）, P〈 0.01] ; which in the temozolomide group had statistical difference between the concurrent period and adjuvant period [RR 0. 48,95 %CI（0. 36,0.65）,P〈0. 01）;but the non-hematological toxic reaction had no statistical difference[RR 1.11,95 % CI（0. 72,1.70）, P= 0.64]. Conclusion Radiotherapy combined with concurrent and then adjuvant temozolomide therapy improves the overall and progression free survival period in the patient with glioblastoma, the higher occurrence rate of hematologic toxic reactions is correlated with temozolomide treatment drugs.