宫颈癌后装治疗中膀胱状态对正常组织剂量影响的Meta分析

摘要

Objective To assess the effects of bladder filling and emptying state on the dose distribution to normal tissue in intracavitary brachytherapy of cervical cancer.Methods We searched databases including PubMed,EMBASE,Cochrane Library,Ongoing Controlled Trial,Chinese Biomedical Literature Database,Chinese Journal FullText Database and Chinese Scientific Journals FullText Database.Quality assessment and data extract was performed for clinical research that met qualifying criteria,then we performed Meta-analysis by StatAl 2.0 software.Results Six studies were involved and 135 patients were included.The Meta-analysis showed that the median dose D50 to the bladder in filling state was significantly lower than in emptying state (SMD=-2.48,95％ CI:-4.37--0.59,P=0.000).D1cm3 and D2cm3 showed no significant difference (P=0.000,0.000).D2cm3 to the rectum in filling state was greater than in emptying state (SMD=0.39,95％ CI:0.06-0.72,P=0.257).D50 and D1cm3 showed no significant difference (P=0.105,0.005).D2cm3 to the sigmoid colon in filling state was greater than in emptying state (SMD=0.81,95％ CI:0.50-1.12,P=0.648).D50 and D1cm3 showed no significant difference (P=0.039,0.000).D1cm3and D2cm3 to the small bowel in filling state was lower than in emptying state (SMD=-3.28,95％ CI:-5.61--0.95,P=0.000 and SMD=-2.98,95％ CI:-4.68--1.28,P=0.000).D50 showed no significant difference (P=0.008).When sensitivity analyses were performed by the sequential dropping of a single study,differences were observed when the study of Patra et al was excluded.Conclusions In intracavitary brachytherapy of cervical cancer,the dose distribution to the bladder and small bowel in filling bladder state were lower than those in emptying bladder state,the results of sigmoid colon and rectum were just opposite.Confined by article quality and quantity,further evaluations in adequately powered large control trail are needed to confirm these findings.%目的 评价宫颈癌后装治疗过程中膀胱充盈和排空两种状态对正常组织剂量分布的影响.方法 计算机检索PubMed、EMBASE、Cochrane Library、Ongoing Controlled Trial、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CJFD)和中文科技期刊全文数据库(CSJD)中相关文献,对符合纳入标准的临床研究进行资料提取和质量评价后,采用Stata12.0软件进行Meta分析.结果 纳入6项研究,共135例患者.分析结果如下:(1)充盈状态膀胱的中位剂量(D50)小于排空状态(SMD =-2.48,95％ CI为-4.37～-0.59,P=0.000).D1cm3和D2cm3的结果相近(P=0.000、0.000).(2)充盈状态直肠的D2cm3剂量大于排空状态(SMD=0.39,95％ CI为0.06～0.72,P=0.257).D50和D1cm3的结果相近(P=0.105、0.005).(3)充盈状态乙状结肠的D2cm3剂量大于排空状态(SMD=0.81,95％ CI为0.50～ 1.12,P=0.648).D50和D1cm3的结果相近(P=0.039、0.000).(4)充盈状态小肠的D1cm3和D2cm3受量小于排空状态(SMD=-3.28,95％ CI为-5.61～-0.95,P=0.000和SMD=-2.98,95％ CI为-4.68-1.28,P=0.000).D50的结果相近(P=0.008).敏感性分析时除剔除Patra等文献后结果不一样外,其余结果均显示与剔除前无差异.结论 宫颈癌后装治疗过程中膀胱充盈状态使得膀胱和小肠受照剂量小于排空状态,直肠和乙状结肠与之相反.受纳入文献数量和质量限制,本分析结果尚有待于高质量的大样本对照试验给予证实.