粒子植入近距离放射治疗与外放射治疗对局限性前列腺癌疗效比较的Meta分析

A meta-analysis of the efficacy of particle implantation brachytherapy and external radiotherapy for localized prostate cancer

目的:比较粒子植入近距离放射治疗与外放射治疗对局限性前列腺癌的疗效。方法:收集国内外已公开发表(截至2017年7月)的有关局限性前列腺癌患者行粒子植入近距离放射治疗与外放射治疗疗效比较的临床对照文献,对符合要求的研究进行同质性检验,并进行Meta分析。结果:符合要求的研究文献共20篇,共12347例病例;其中行单独粒子植入近距离放射治疗的患者4414例,行单独外放射治疗的患者6508例,行联合治疗的患者1425例。粒子植入近距离放疗治疗低危局限型前列腺癌的5年无肿瘤生存人数、生存时间以及胃肠道毒性评分≥2分的患者人数均优于外放射治疗,差异有统计学意义(P<0.05),两者联合治疗中高危局限型前列腺癌的生化无进展生存时间优于单独治疗,差异有统计学意义(P<0.05)。结论:Meta分析结果显示单独粒子植入近距离放射治疗对于低危局限性前列腺癌的疗效及安全性优于单独外放射治疗,两者联合治疗对中高危局限性前列腺癌的疗效优于单独治疗。

Objective:To compare the therapeutic effect of external radiotherapy and brachytherapy in the treatment of localized prostate cancer.Methods:Published literatures domestic and abroad about the brachytherapy and external radiotherapy for localized prostate cancer until July 2017 were collected.Homogeneity test in studies meeting the required criteria was performed and Meta analysis was done.Results:Twenty papers including 12347 cases met the requirements of study.Of which,4414 cases were treated with external radiotherapy,6508 cases with brachytherapy and 1425 cases with conjoint therapy of the two.Patients with low-risk localized prostate cancer which using brachytherapy,the number of five-year disease free survival,overall survival time and patients with gastrointestinal toxicity with score≥2 were better than that of external radiotherapy(P<0.05).For intermediate and high risk localized prostate cancer which using conjoint therapy,the disease free survival was better than that with separate treatment(P<0.05).Conclusion:According to current research results,the efficacy and safety using brachytherapy for low risk localized prostate cancer was better than that of external radiotherapy.The efficacy using conjoint therapy for intermediate and high risk localized prostate cancer was better than that of separate treatment.