食管癌三维适形放疗临床靶体积对预后影响的Meta分析

摘要

Objective To evaluate the clinical efficacy and toxicities of the three-dimensional conformal radiotherapy for esophageal carcinoma by analyzing the different clinical target volume. Methods An electronic search was performered in American medical literature index (MEDLINE), China national knowledge infrastructure (CNKI) digital library, China biomedicine literature database(CBM) and Chinese science and technology periodical database (VIP). The trials were collected and evaluated according to the inclusion and exclusion criteria. The meta-analysis was performed for the results of homogeneous studies by RevMan 5.1.6 software. Results The meta-analysis included 5 trials. A total of 405 patients were included in the analysis. There was no statistically significant difference in 1-year survival rate between the experimental group and the control group with RR 1.05, 95%CI (0.65,1.71), P=0.83; the similar results also were found in 1-year locoregional control rate with RR 0.92, 95%CI (0.57, 1.50), P=0.75; However the radioactive pneumonia, radiation esophagitis for the two groups had statistical significant difference with RR 1.79, 95%CI (1.14,2.82), P=0.01 and RR 1.98, 95%CI (1.11,3.51), P=0.02, respectively. Conclusion Compared with control group, the experimental group based on large radiation field did not improve 1-year survival rate and 1-year locoregional control rate of patients, but increased higher incidence of radioactive pneumonia and radiation esophagitis in patients. In the radiotherapy of esophageal carcinoma, the results of this study including few cases that needs a larger sample, multi-center randomized controlled trials to be evidenced.%目的 评估三维适形放疗不同临床靶体积对食管癌的疗效及副作用.方法 计算机检索美国医学文献索引(MEDLINE)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP).对收集的文章进行评价,剔除不适合本文研究目的或质量要求的文章.对同质的研究,采用RevMan5.1.6软件进行Meta分析.结果 共纳入5项随机对照研究,包括405例患者.Meta分析结果显示:试验组与对照组相比,1年生存率优势比1.05,95％可信区间(0.65,1.71),P值为0.83,差异无统计学意义；1年局部控制率优势比0.92,95％可信区间(0.57,1.50),P值为0.75,差异无统计学意义.放射性肺炎优势比1.79,95％可信区间(1.14,2.82),P值为0.01;放射性食管炎优势比1.98,95％可信区间(1.11,3.51),P值为0.02,差异有统计学意义.结论在食管癌的三维适形放疗中,以大照射野为基础试验组与对照组比较,并不能改善患者1年生存率和1年局部控制率,反而增加患者放射性肺炎和放射性食管炎发生率.本研究纳入病例较少,其结果尚需要多中心大样本随机对照试验进一步验证.