Lester J F, Macbeth F R, Toy E, Coles B
Velindre Hospital NHS Trust, Oncology, Velindre Road, Cardiff, South Glamorgan, UK.
Cochrane Database Syst Rev. 2006 Oct 18(4):CD002143. doi: 10.1002/14651858.CD002143.pub2.
Palliative radiotherapy to the chest is often used in patients with lung cancer, but radiotherapy regimens are more often based on tradition than research results.
To discover the most effective and least toxic regimens of palliative radiotherapy for non-small cell lung cancer, and whether higher doses increase survival.
The electronic databases MEDLINE, EMBASE, Cancerlit and the Cochrane Central Register of Controlled Trials, reference lists, handsearching of journals and conference proceedings, and discussion with experts were used to identify potentially eligible trials, published and unpublished.
Randomised controlled clinical trials comparing different regimens of palliative radiotherapy in patients with non-small cell lung cancer.
Fourteen randomised trials were reviewed. There were important differences in the doses of radiotherapy investigated, the patient characteristics and the outcome measures. Because of this heterogeneity no meta-analysis was attempted.
There is no strong evidence that any regimen gives greater palliation. Higher dose regimens give more acute toxicity, especially oesophagitis. There is evidence for a modest increase in survival (5% at 1 year and 3% at 2 years) in patients with better performance status (PS) given higher dose radiotherapy. Some regimens are associated with an increased risk of radiation myelitis.
AUTHORS' CONCLUSIONS: The majority of patients should be treated with short courses of palliative radiotherapy, of 1 or 2 fractions. Care should be taken with the dose to the spinal cord. The use of high dose palliative regimens should be considered for and discussed with selected patients with good performance status. More research is needed into reducing the acute toxicity of large fraction regimens and into the role of radical compared to high dose palliative radiotherapy. In the future, large trials comparing different RT regimens may be difficult to set up because of the increasing use of systemic chemotherapy. Trials looking at how best to integrate these two modalities, particularly in good PS patients, need to be carried out.
胸部姑息性放疗常用于肺癌患者，但放疗方案更多基于传统而非研究结果。
探寻非小细胞肺癌姑息性放疗最有效且毒性最小的方案，以及更高剂量是否能提高生存率。
使用电子数据库MEDLINE、EMBASE、Cancerlit和Cochrane对照试验中央注册库、参考文献列表、手工检索期刊和会议论文集，并与专家讨论，以识别潜在符合条件的已发表和未发表试验。
比较非小细胞肺癌患者不同姑息性放疗方案的随机对照临床试验。
回顾了14项随机试验。所研究的放疗剂量、患者特征和结局指标存在重要差异。由于这种异质性，未尝试进行荟萃分析。
没有有力证据表明任何方案能带来更好的姑息效果。更高剂量方案会产生更多急性毒性，尤其是食管炎。有证据表明，身体状况较好（PS）的患者接受更高剂量放疗后，生存率有适度提高（1年时提高5%，2年时提高3%）。一些方案与放射性脊髓炎风险增加有关。
大多数患者应接受1或2次分割的短疗程姑息性放疗。应注意脊髓剂量。对于身体状况良好的特定患者，应考虑并讨论使用高剂量姑息方案。需要更多研究来降低大分割方案的急性毒性，以及根治性放疗与高剂量姑息性放疗相比的作用。未来，由于全身化疗的使用增加，可能难以开展比较不同放疗方案的大型试验。需要开展研究以确定如何最好地整合这两种治疗方式，特别是对于身体状况良好的患者。
