Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Lancet Oncol. 2014 Aug;15(9):1027-38. doi: 10.1016/S1470-2045(14)70268-2. Epub 2014 Jun 26.
Malignant tumours arising within the nasal cavity and paranasal sinuses are rare and composed of several histological types, rendering controlled clinical trials to establish the best treatment impractical. We undertook a systematic review and meta-analysis to compare the clinical outcomes of patients treated with charged particle therapy with those of individuals receiving photon therapy.
We identified studies of nasal cavity and paranasal sinus tumours through searches of databases including Embase, Medline, Scopus, and the Cochrane Collaboration. We included treatment-naive cohorts (both primary and adjuvant radiation therapy) and those with recurrent disease. Primary outcomes of interest were overall survival, disease-free survival, and locoregional control, at 5 years and at longest follow-up. We used random-effect models to pool outcomes across studies and compared event rates of combined outcomes for charged particle therapy and photon therapy using an interaction test.
43 cohorts from 41 non-comparative observational studies were included. Median follow-up for the charged particle therapy group was 38 months (range 5-73) and for the photon therapy group was 40 months (14-97). Pooled overall survival was significantly higher at 5 years for charged particle therapy than for photon therapy (relative risk 1·51, 95% CI 1·14-1·99; p=0·0038) and at longest follow-up (1·27, 1·01-1·59; p=0·037). At 5 years, disease-free survival was significantly higher for charged particle therapy than for photon therapy (1·93, 1·36-2·75, p=0·0003) but, at longest follow-up, this event rate did not differ between groups (1·51, 1·00-2·30; p=0·052). Locoregional control did not differ between treatment groups at 5 years (1·06, 0·68-1·67; p=0·79) but it was higher for charged particle therapy than for photon therapy at longest follow-up (1·18, 1·01-1·37; p=0·031). A subgroup analysis comparing proton beam therapy with intensity-modulated radiation therapy showed significantly higher disease-free survival at 5 years (relative risk 1·44, 95% CI 1·01-2·05; p=0·045) and locoregional control at longest follow-up (1·26, 1·05-1·51; p=0·011).
Compared with photon therapy, charged particle therapy could be associated with better outcomes for patients with malignant diseases of the nasal cavity and paranasal sinuses. Prospective studies emphasising collection of patient-reported and functional outcomes are strongly encouraged.
Mayo Foundation for Medical Education and Research.
鼻腔和鼻窦内发生的恶性肿瘤较为罕见，由多种组织学类型组成，这使得开展旨在确定最佳治疗方法的对照临床试验变得不切实际。我们开展了一项系统评价和荟萃分析，旨在比较接受带电粒子治疗和光子治疗的患者的临床结局。
我们通过检索 Embase、Medline、Scopus 和 Cochrane 协作网等数据库，确定了鼻腔和鼻窦肿瘤的研究。我们纳入了未经治疗的队列（包括原发性和辅助性放疗）和复发性疾病患者。主要观察终点为 5 年及最长随访时的总生存、无病生存和局部区域控制。我们使用随机效应模型汇总研究结果，并使用交互检验比较带电粒子治疗和光子治疗的联合结局的事件发生率。
纳入了 41 项非对照观察性研究的 43 个队列。带电粒子治疗组的中位随访时间为 38 个月（5-73 个月），光子治疗组为 40 个月（14-97 个月）。带电粒子治疗组 5 年总生存率显著高于光子治疗组（相对风险 1.51，95%CI 1.14-1.99；p=0.0038）和最长随访时（1.27，1.01-1.59；p=0.037）。5 年时，带电粒子治疗的无病生存率显著高于光子治疗（1.93，1.36-2.75，p=0.0003），但在最长随访时，两组间该结局无差异（1.51，1.00-2.30；p=0.052）。5 年时，局部区域控制两组间无差异（1.06，0.68-1.67；p=0.79），但最长随访时带电粒子治疗的局部区域控制优于光子治疗（1.18，1.01-1.37；p=0.031）。一项比较质子束治疗与调强放疗的亚组分析显示，5 年时无病生存率显著更高（相对风险 1.44，95%CI 1.01-2.05；p=0.045），最长随访时局部区域控制也更高（1.26，1.05-1.51；p=0.011）。
与光子治疗相比，带电粒子治疗可能为鼻腔和鼻窦恶性疾病患者带来更好的结局。强烈鼓励开展强调收集患者报告和功能结局的前瞻性研究。
梅奥基金会医学教育和研究。
