局限期小细胞肺癌胸部精确放疗的网状Meta分析

Precision thoracic radiotherapy in limited-stage small cell lung cancer:a network meta-analysis

目的评价精确胸部放射治疗(TRT)局限期小细胞肺癌(LS-SCLC)的有效性及安全性。方法计算机检索PubMed、Web of Science、Cochrane Library、中国知网(CNKI)和万方数据库,搜集LS-SCLC TRT的随机对照试验(RCT),检索时限均从建库至2021年09月01日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 17和R 4.1.1软件进行网状Meta分析。结果共纳入6个RCT,共计1730例患者,涉及6种放疗方案,分别为:超分割放疗(HFRT):45Gy分30次(HFRT_(45))和60Gy分40次(HFRT_(60));常规分割放疗(CFRT):70Gy分35次(CFRT_(70))、66Gy分33次(CFRT_(66));中度大分割放疗(MHFRT):65Gy分26次(MHFRT_(65))和42Gy分15次(MHFRT_(42))。网状Meta分析结果显示,在改善无进展生存期、总生存期方面,6种放疗方案之间比较差异均无统计学意义。概率排序结果分别为MHFRT_(65)>HFRT_(60)>CFRT_(66)>CFRT_(70)>MHFRT_(42)>HFRT_(45)、HFRT_(60)>MHFRT_(65)>CFRT_(66)>CFRT_(70)>HFRT_(45)>MHFRT_(42)。HFRT_(60)方案在降低3级及以上肺炎发生率方面优于其他方案,而各方案导致3级及以上放射性食管炎方面并无差异,概率排序结果分别为HFRT_(60)>MHFRT_(42)>CFRT_(66)>CFRT_(70)>HFRT_(45)>MHFRT_(65)、HFRT_(60)>CFRT_(70)>CFRT_(66)>HFRT_(45)>MHFRT_(42)>MHFRT_(65)。结论HFRT_(60)方案治疗LS-SCLC患者的疗效及安全性可能更优。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically evaluate the efficacy and safety of precision thoracic radiotherapy(TRT)in the limited-stage small cell lung cancer(LS-SCLC)patients by network meta-analysis.Methods Randomized controlled trials(RCTs)of TRT regimes in the LS-SCLC were electronically searched from PubMed,Web of Science,The Cochrane Library,CNKI and Wanfang Data from inception to September 1st,2021.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Statistical analysis was performed by Stata 17 and R 4.1.1software.Results A total of 6 RCTs involving 1730 patients with six radiation regimens including hyperfractionated radiotherapy(HFRT):HFRT_(45)(45Gy/30 F)and HFRT_(60)(60Gy/40 F);conventional fractionated radiotherapy(CFRT):CFRT_(70)(70Gy/35 F)and CFRT_(66)(66Gy/33 F);moderately hypofractionated radiotherapy(MHFRT):MHFRT_(65)(65Gy/26 F)and MHFRT_(42)(42Gy/15 F)were included.The network meta-analysis showed that:in terms of improving progression-free survival and overall survival,there was no statistically significant difference among the six radiotherapy regimens.The probabilistic ranking results were:MHFRT_(65)>HFRT_(60)>CFRT_(66)>CFRT_(70)>MHFRT_(42)>HFRT_(45),and HFRT_(60)>MHFRT_(65)>CFRT_(66)>CFRT_(70)>HFRT_(45)>MHFRT42,respectively.The HFRT60 regimen was superior to other regimens in reducing the incidence of grade≥3 pneumonia,and there was no difference between the regimens in causing grade≥3 radiation esophagitis,and the results of ranking probability were:HFRT_(60)>MHFRT_(42)>CFRT_(66)>CFRT_(70)>HFRT_(45)>MHFRT_(65),and HFRT_(60)>CFRT_(70)>CFRT_(66)>HFRT_(45)>MHFRT_(42)>MHFRT_(65),respectively.Conclusions HFRT60 radiotherapy regimen may be more effective and safer in the treatment of LS-SCLC patients as a priority choice for LS-SCLC TRT.Limited by the number and quality of included studies,the above conclusions need to be verified by more high-quality studies.