發(fā)布時(shí)間：2018-01-07 07:43

  本文關(guān)鍵詞：食管鱗癌精準(zhǔn)放療技術(shù)下累及野照射與選擇性淋巴引流區(qū)照射Meta分析　出處：《中華腫瘤防治雜志》2017年02期 　論文類型：期刊論文

  更多相關(guān)文章： 食管腫瘤 三維適形/調(diào)強(qiáng)放射療法 累及野照射 臨床靶體積

【摘要】：目的進(jìn)入三維適形/調(diào)強(qiáng)放射治療時(shí)代,食管鱗癌患者行根治性放療是否需要進(jìn)行選擇性淋巴引流區(qū)照射(elective nodal irradiation,ENI),或僅需累及野照射(involved-field irradiation,IFI)仍存在爭(zhēng)議,因此本研究應(yīng)用Meta分析方法比較食管鱗癌三維適形/調(diào)強(qiáng)放射治療采用IFI與ENI的療效和毒副作用,為臨床應(yīng)用提供參考。方法檢索中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)、中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)、Cochrane Library、PubMed和EMbase等國(guó)內(nèi)外數(shù)據(jù)庫(kù)有關(guān)食管鱗癌精準(zhǔn)放射治療條件下IFI與ENI對(duì)比的文獻(xiàn),末次檢索時(shí)間2016-08-31。依據(jù)入選和排除標(biāo)準(zhǔn),收集各項(xiàng)研究中有關(guān)臨床療效、毒副反應(yīng)及失敗模式,應(yīng)用Meta分析方法比較IFI與ENI在臨床治療食管鱗癌患者中的優(yōu)劣。結(jié)果初檢出文獻(xiàn)63篇,剔除學(xué)位論文/會(huì)議投稿或非北大醫(yī)學(xué)圖書館收錄文獻(xiàn)18篇。進(jìn)一步閱讀全文,排除數(shù)據(jù)重復(fù)發(fā)表文獻(xiàn)20篇,采用二維技術(shù)2篇以及非病例對(duì)照研究14篇,最終納入符合標(biāo)準(zhǔn)的國(guó)內(nèi)外文獻(xiàn)9篇。共包括1 143例患者,其中采用單純放療605例,放化綜合治療538例。結(jié)果顯示,IFI組與ENI組相比1、2和3年局部控制率差異無統(tǒng)計(jì)學(xué)意義(OR=0.759,95%CI為0.572~1.008,P=0.057;OR=1.076,95%CI為0.790~1.466,P=0.641;OR=0.977,95%CI為0.726~1.315,P=0.879),1、2和3年OS差異無統(tǒng)計(jì)學(xué)意義(HR=0.824,95%CI為0.623~1.091,P=0.959;HR=1.030,95%CI為0.715~1.483,P=0.206;HR=0.846,95%CI為0.488~1.465,P=0.551),但≥3級(jí)放射性食管炎、≥3級(jí)放射性肺炎發(fā)生率累及野組明顯降低(OR=0.515,95%CI為0.341~0.778,P=0.002;OR=0.481,95%CI為0.254~0.913,P=0.025)。兩組野外復(fù)發(fā)/轉(zhuǎn)移率差異無統(tǒng)計(jì)學(xué)意義,OR=1.629,95%CI為0.708~3.747,P=0.251。結(jié)論食管鱗癌精準(zhǔn)照射條件下IFI組局部控制率、生存率與ENI組差異無統(tǒng)計(jì)學(xué)意義,而重度放射性食管炎和放射性肺炎的發(fā)生率明顯降低,且IFI照射并不增加野外復(fù)發(fā)/轉(zhuǎn)移幾率�？紤]到納入文獻(xiàn)大多為回顧性研究,因此尚需開展大宗的前瞻性隨機(jī)對(duì)照研究進(jìn)行驗(yàn)證。
[Abstract]:Objective to enter the age of three-dimensional conformal / intensity modulated radiotherapy. Whether selective nodal irradiation is necessary for patients with esophageal squamous cell carcinoma after radical radiotherapy. It is still controversial that only involved-field irradiationsIFI should be involved. In this study, Meta analysis was used to compare the efficacy and side effects of IFI and ENI in three-dimensional conformal / intensity modulated radiotherapy for esophageal squamous cell carcinoma. Methods Chinese biomedical literature database and Chinese academic journal full-text database were searched for clinical application. PubMed, EMbase and other databases at home and abroad on esophageal squamous cell carcinoma under the conditions of accurate radiotherapy IFI and ENI comparison literature. The last retrieval time was 2016-08-31.According to the criteria of inclusion and exclusion, the clinical efficacy, toxicity and failure patterns were collected. Meta analysis was used to compare the advantages and disadvantages of IFI and ENI in the treatment of esophageal squamous cell carcinoma. 18 papers collected from academic papers / conference papers or non-Peking University medical library were excluded. Further reading of the full text and excluding data duplication published 20 articles. Two dimensional techniques and 14 non-case-control studies were used, and 9 domestic and foreign literatures were included. A total of 1,143 patients were included, of whom 605 were treated with radiotherapy alone. The results showed that there was no significant difference in the local control rate between the IFI group and the ENI group in 1 ~ 2 years and 3 years after combined radiotherapy and chemotherapeutic therapy, and there was no significant difference in the local control rate between the IFI group and the ENI group. 95 CI was 0.572U 1.008Pu 0.057; The CI of ORA 1.076 ~ 95C was 0.790 ~ 1.466p ~ (0.641); There was no significant difference between 0.977and 95CI (0.726 / 1. 315) and 3 years (P = 0.879) and 3 years (P < 0. 824). 95 CI was 0.623, 1.091, P0. 959; The CI of HRN 1.030 and 95% was 0.715 ~ 1.483C = 0.206; The CI of HRN 0.846 / 95 was 0.488U 1.465P 0.551g, but 鈮，

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