Terasawa Teruhiko, Dvorak Tomas, Ip Stanley, Raman Gowri, Lau Joseph, Trikalinos Thomas A
Tufts Medical Center Evidence-based Practice Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Ann Intern Med. 2009 Oct 20;151(8):556-65. doi: 10.7326/0003-4819-151-8-200910200-00145. Epub 2009 Sep 14.
Radiation therapy with charged particles can potentially deliver maximum doses while minimizing irradiation of surrounding tissues, and it may be more effective or less harmful than other forms of radiation therapy.
To review evidence about the benefits and harms of charged-particle radiation therapy for patients with cancer.
MEDLINE (inception to 11 July 2009) was searched for publications in English, German, French, Italian, and Japanese. Web sites of manufacturers, treatment centers, and professional organizations were searched for relevant information.
Four reviewers identified studies of any design that described clinical outcomes or adverse events in 10 or more patients with cancer treated with charged-particle radiation therapy.
The 4 reviewers extracted study, patient, and treatment characteristics; clinical outcomes; and adverse events for nonoverlapping sets of articles. A fifth reviewer verified data on comparative studies.
Currently, 7 centers in the United States have facilities for particle (proton)-beam irradiation, and at least 4 are under construction, each costing between $100 and $225 million. In 243 eligible articles, charged-particle radiation therapy was used alone or in combination with other interventions for common (for example, lung, prostate, or breast) or uncommon (for example, skull-base tumors or uveal melanomas) types of cancer. Of 243 articles, 185 were single-group retrospective studies. Eight randomized and 9 nonrandomized clinical trials compared treatments with or without charged particles. No comparative study reported statistically significant or important differences in overall or cancer-specific survival or in total serious adverse events.
Few studies directly compared treatments with or without particle irradiation.
Evidence on the comparative effectiveness and safety of charged-particle radiation therapy in cancer is needed to assess the benefits, risks, and costs of treatment alternatives.
带电粒子放射治疗有可能在使周围组织受照射剂量最小化的同时给予最大剂量，并且可能比其他形式的放射治疗更有效或危害更小。
综述关于带电粒子放射治疗对癌症患者的益处和危害的证据。
检索MEDLINE（起始至2009年7月11日）中英语、德语、法语、意大利语和日语的出版物。检索制造商、治疗中心和专业组织的网站以获取相关信息。
四名评审员确定了任何设计的研究，这些研究描述了10名或更多接受带电粒子放射治疗的癌症患者的临床结局或不良事件。
四名评审员提取了研究、患者和治疗特征；临床结局；以及不重叠文章集的不良事件。第五名评审员核实了比较研究的数据。
目前，美国有7个中心具备粒子（质子）束照射设施，至少4个正在建设中，每个造价在1亿至2.25亿美元之间。在243篇符合条件的文章中，带电粒子放射治疗单独使用或与其他干预措施联合用于常见（如肺癌、前列腺癌或乳腺癌）或罕见（如颅底肿瘤或葡萄膜黑色素瘤）类型的癌症。在243篇文章中，185篇为单组回顾性研究。八项随机和九项非随机临床试验比较了有或没有带电粒子的治疗。没有比较研究报告在总生存或癌症特异性生存或总严重不良事件方面有统计学显著或重要差异。
很少有研究直接比较有或没有粒子照射的治疗。
需要关于带电粒子放射治疗在癌症治疗中的比较有效性和安全性的证据，以评估治疗选择的益处、风险和成本。
