Chapman E, Berenstein E G, Diéguez M, Ortiz Z
Cochrane Database Syst Rev. 2006 Jul 19;2006(3):CD003880. doi: 10.1002/14651858.CD003880.pub4.
Malignant pleural mesothelioma is a relatively uncommon disease, but the incidence is increasing and is expected to peak in many developed countries in the next two decades. The management of patients with malignant mesothelioma is controversial. Very few patients are suitable for any potentially curative treatment and the effectiveness of radical therapy with surgery, radiotherapy and/or chemotherapy in curing patients or prolonging survival is uncertain. The role of radiotherapy is controversial although it has been used as part of multimodal therapy. The present review will try to clarify these uncertainties.
To assess the effectiveness and safety of radiotherapy on patients with malignant pleural mesothelioma in any stage of the disease.
Both electronic and handsearches were conducted. All randomised controlled clinical trials were searched in electronic databases such as: Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Handsearching was aimed at the identification of evidence by reviewing journals not indexed in databases, proceedings of conferences and/or scientific meetings.
All randomised controlled clinical trials using radiotherapy for malignant pleural mesothelioma in any stage, alone or combined with other therapies in patients of either sex and any age, were included. Studies without a control group were excluded.
There were no studies that fulfilled the inclusion criteria.
To date we have not found any reports of randomised comparisons of radiotherapy alone or combined for patients with malignant pleural mesothelioma.
AUTHORS' CONCLUSIONS: As radiotherapy has never been compared to chemotherapy or surgery or to best supportive care (as part of combination therapy) in a prospective, randomised trial, no data exist supporting one or the other treatment as a better option for patients with malignant pleural mesothelioma. There is a need for multicentre controlled randomised trials assessing the role of radiotherapy in the radical treatment of malignant pleural mesothelioma. The studies should be limited to patients with malignant pleural mesothelioma, classified by stage, cytology and type of radiotherapy. The type of radiotherapy should be defined in advance and variables of radiotherapy dose definition and delivery should be carefully controlled.
恶性胸膜间皮瘤是一种相对罕见的疾病，但发病率正在上升，预计在未来二十年里在许多发达国家将达到峰值。恶性间皮瘤患者的治疗存在争议。很少有患者适合任何可能治愈性的治疗，手术、放疗和/或化疗的根治性治疗在治愈患者或延长生存期方面的有效性尚不确定。放疗的作用存在争议，尽管它已被用作多模式治疗的一部分。本综述将试图阐明这些不确定性。
评估放疗对处于疾病任何阶段的恶性胸膜间皮瘤患者的有效性和安全性。
进行了电子检索和手工检索。在电子数据库如Cochrane对照试验中央登记册、MEDLINE和EMBASE中检索了所有随机对照临床试验。手工检索旨在通过查阅未被数据库索引的期刊、会议论文集和/或科学会议来识别证据。
纳入所有在任何阶段使用放疗治疗恶性胸膜间皮瘤的随机对照临床试验，放疗可单独使用或与其他疗法联合使用，患者性别不限，年龄不限。排除没有对照组的研究。
没有符合纳入标准的研究。
迄今为止，我们尚未发现任何关于单独放疗或联合放疗用于恶性胸膜间皮瘤患者的随机对照比较的报告。
由于放疗从未在前瞻性随机试验中与化疗、手术或最佳支持治疗（作为联合治疗的一部分）进行比较，因此不存在支持一种或另一种治疗作为恶性胸膜间皮瘤患者更好选择的数据。需要进行多中心对照随机试验来评估放疗在恶性胸膜间皮瘤根治性治疗中的作用。研究应限于根据分期、细胞学和放疗类型分类的恶性胸膜间皮瘤患者。放疗类型应预先确定，放疗剂量定义和给予的变量应仔细控制。
