Glenny Anne-Marie, Furness Susan, Worthington Helen V, Conway David I, Oliver Richard, Clarkson Jan E, Macluskey Michaelina, Pavitt Sue, Chan Kelvin Kw, Brocklehurst Paul
Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Road, Manchester, UK, M13 9PL.
Cochrane Database Syst Rev. 2010 Dec 8;2010(12):CD006387. doi: 10.1002/14651858.CD006387.pub2.
The management of advanced oral cavity and oropharyngeal cancers is problematic and has traditionally relied on surgery and radiotherapy, both of which are associated with substantial adverse effects. Radiotherapy has been in use since the 1950s and has traditionally been given as single daily doses. This method of dividing up the total dose, or fractionation, has been modified over the years and a variety of approaches have been developed with the aim of improving survival whilst maintaining acceptable toxicity.
To determine which radiotherapy regimens for oral cavity and oropharyngeal cancers result in increased overall survival, disease free survival, progression free survival and locoregional control.
The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 28 July 2010), CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE via OVID (1950 to 28 July 2010) and EMBASE via OVID (1980 to 28 July 2010). There were no restrictions regarding language or date of publication.
Randomised controlled trials where more than 50% of participants had primary tumours of the oral cavity or oropharynx, and which compared two or more radiotherapy regimens, radiotherapy versus other treatment modality, or the addition of radiotherapy to other treatment modalities.
Data extraction and assessment of risk of bias was undertaken independently by two or more authors. Study authors were contacted for additional information as required. Adverse events data were collected from published trials.
30 trials involving 6535 participants were included. Seventeen trials compared some form of altered fractionation (hyperfractionation/accelerated) radiotherapy with conventional radiotherapy; three trials compared different altered fractionation regimens; one trial compared timing of radiotherapy, five trials evaluated neutron therapy and four trials evaluated the addition of pre-operative radiotherapy. Pooling trials of any altered fractionation radiotherapy compared to a conventional schedule showed a statistically significant reduction in total mortality (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76 to 0.98). In addition, a statistically significant difference in favour of the altered fractionation was shown for the outcome of locoregional control (HR 0.79, 95% CI 0.70 to 0.89). No statistically significant difference was shown for disease free survival.No statistically significant difference was shown for any other comparison.
AUTHORS' CONCLUSIONS: Altered fractionation radiotherapy is associated with an improvement in overall survival and locoregional control in patients with oral cavity and oropharyngeal cancers. More accurate methods of reporting adverse events are needed in order to truly assess the clinical performance of different radiotherapy regimens.
晚期口腔癌和口咽癌的治疗存在问题，传统上依赖手术和放疗，这两种方法都有严重的不良反应。放疗自20世纪50年代开始应用，传统上采用每日单次剂量给药。多年来，这种将总剂量分割的方法，即分割放疗，已有所改进，并开发了多种方法，目的是在维持可接受毒性的同时提高生存率。
确定哪些口腔癌和口咽癌的放疗方案能提高总生存率、无病生存率、无进展生存率和局部区域控制率。
检索了以下电子数据库：Cochrane口腔健康组试验注册库（至2010年7月28日）、CENTRAL（Cochrane图书馆2010年第3期）、通过OVID检索的MEDLINE（1950年至2010年7月28日）以及通过OVID检索的EMBASE（1980年至2010年7月28日）。对语言或出版日期没有限制。
随机对照试验，其中超过50%的参与者患有口腔或口咽原发性肿瘤，且比较了两种或更多种放疗方案、放疗与其他治疗方式，或放疗联合其他治疗方式。
由两名或更多作者独立进行数据提取和偏倚风险评估。根据需要与研究作者联系以获取更多信息。不良事件数据从已发表的试验中收集。
纳入了30项试验，涉及6535名参与者。17项试验比较了某种形式的分割放疗（超分割/加速分割）与传统放疗；3项试验比较了不同的分割放疗方案；1项试验比较了放疗时间，5项试验评估了中子治疗，4项试验评估了术前放疗的添加。将任何分割放疗与传统放疗方案进行汇总试验显示，总死亡率有统计学显著降低（风险比（HR）0.86，95%置信区间（CI）0.76至0.98）。此外，在局部区域控制结果方面，显示出有利于分割放疗的统计学显著差异（HR 0.79，95%CI 0.70至0.89）。无病生存率未显示出统计学显著差异。其他任何比较均未显示出统计学显著差异。
分割放疗与口腔癌和口咽癌患者的总生存率和局部区域控制改善相关。需要更准确的不良事件报告方法，以便真正评估不同放疗方案的临床性能。
