局限期SCLC超分割比常规分割放化疗疗效及安全性Meta分析

Efficacy and safety of hyperfractionated versus conventionally fractionated chemoradiotherapy for limited-stage small-cell lung cancer： a meta-analysis

目的 系统评价放化疗治疗局限期SCLC时超分割与常规分割不同放疗模式有效性及安全性差异。方法 计算机检索Pubmed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方、中国知网和维普等数据库,查找超分割对比常规分割放化疗治疗局限期SCLC的临床对照研究文献。使用Revman 5.3统计软件对近期疗效、生存资料及不良反应进行Meta分析。结果 纳入8篇临床对照研究文献,共计1 361例患者。Meta分析结果显示,超分割组与常规分割组有着相似的客观缓解率（OR=1.31,95%CI为 0.64~2.69,P=0.46）;两组间2、5年OS率相近（RR=1.10,95%CI为 0.98~1.24,P=0.12;RR=1.13,95%CI为 0.75~1.69,P=0.56）;超分割组的≥2级放射性食管炎发生率较常规分割组高（RR=1.74,95%CI为 1.39~2.17,P〈0.05）,但两组间≥2级的放射性肺炎（RR=0.73,95%CI：0.24~2.24,P=0.58）、〉3级血液学毒性（RR=1.18,95%CI为 0.99~1.39,P=0.06）发生率相近。结论 在局限期SCLC放化疗中两种放疗分割模式的近期疗效与生存获益相当,但超分割放疗的放射性食管炎发生率较高。超分割放疗并未带来较常规分割放疗更多的优越性。

Objective To systematically evaluate the differences in efficacy and safety between hyperfractionated and conventionally fractionated radiotherapy for limited-stage small-cell lung cancer （LS-SCLC）. Methods A computerized search was performed in PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang Data, CNKI, and VIP to collect controlled clinical trials of hyperfractionated versus conventionally fractionated chemoradiotherapy in the treatment of LS-SCLC. The RevMan 5.3 softwarewas used to perform meta-analyses of short-term outcomes, survival data, and adverse events. Results Eight controlled clinical trials involving 1361 patients were enrolled in this study. The results of meta-analysis showed that there were no significant differences in objective response rate or 2-and 5-year overall survival rates between the hyperfractionation group and the conventional fractionation group （odds ratio[OR]=1.31, 95% confidence interval[CI]：0.64-2.69,P=0.46;risk ratio[RR]=1.10, 95%CI：0.98-1.24,P=0.12;RR=1.13,95%CI：0.75-1.69,P=0.56）. Compared with the conventional fractionation group, the hyperfractionation group had a significantly higher incidence of grade ≥2 radiation esophagitis （RR=1.74, 95%CI：1.39-2.17,P〈0.05）. However, there were no significant differences in incidence rates of grade ≥2 radiation pneumonitis or grade 〉3 hematological toxicity between the two groups （RR=0.73, 95%CI：0.24-2.24,P=0.58;RR=1.18, 95%CI：0.99-1.39,P=0.06）. Conclusions In the treatment of LS-SCLC, two fractionation modes show similar short-term efficacy and survival benefits. However, hyperfractionated radiotherapy causes a higher incidence of radiation esophagitis than conventionally fractionated radiotherapy. Given that hyperfractionated radiotherapy is not superior to conventionally fractionated radiotherapy, conventionally fractionated radiotherapy is recommended for treating LS-SCLC.