外用皮质类固醇预防放射性皮炎效果的meta分析

Effect of topical corticosteroids for preventing radiation dermatitis: a meta analysis

目的系统评价外用皮质类固醇(TCS)在改善肿瘤放射性皮炎及患者主观报告症状上的作用。方法检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science、Embase、CINHAL数据库中关于TCS对肿瘤患者放射性皮炎作用的随机对照试验(RCT),检索时间不限。对符合纳入标准的文献进行数据提取,并使用RevMan5.3软件进行统计分析。结果共纳入12篇RCT,meta分析结果显示,TCS能减少放疗患者≥3级放射性皮炎或湿性脱皮的发生[OR=0.63,95%CI(0.33,0.62),P<0.01],但亚组分析结果显示,这种作用在头颈部肿瘤患者中可能不明显[OR=0.72,95%CI(0.45,1.14),P=0.16]。此外在放射性皮炎患者主观报告症状上,TCS的使用并不能减少疼痛症状。结论TCS可改善乳腺癌患者≥3级放射性皮炎或湿性脱皮,但是其在头颈部肿瘤患者中的作用尚需要更多的研究以验证。

Objective To systematically evaluate the role of topical corticosteroids(TCS) in improving tumor radiation dermatitis and the patient’s subjectively reported symptoms.Methods The randomized controlled trial on the effect of TCS on radiation dermatitis in tumor patients were systematically retrieved from the databases of CNKI,Wanfang data, VIP,PubMed, Cochrane Library, Web of Science, Embase, and CINHAL database.The retrieval time was unlimited.The literatures meeting the inclusion criteria conducted the data extraction, and the statistical analysis was performed by using RevMan 5.3 software.Results A total of 12 RCTs were included.The meta analysis results showed that TCS could reduce the occurrence of radiation dermatitis(grade ≥3) or wet desquamation in the radiotherapeutic patients [OR=0.63,95%CI(0.33,0.62),P<0.01],but the subgroup analysis results showed that this effect might not be significant in the patients with head and neck tumor [OR=0.72,95%CI(0.45,1.14),P=0.16].In addition, in the subjective reported symptoms in the patients with radiation dermatitis, the TCS use did not reduce the pain caused by radiation dermatitis.Conclusion TCS could improve radiation dermatitis(grade ≥3) or wet desquamation in the patients with breast cancer, but its role in the patients with head and neck tumor needs to be validated by more studies.