全脑放疗联合吉非替尼/厄洛替尼治疗非小细胞肺癌脑转移：一项荟萃分析
Combining Whole-Brain Radiotherapy with Gefitinib/Erlotinib for Brain Metastases from Non-Small-Cell Lung Cancer: A Meta-Analysis.
作者信息
Zheng Mao-hua, Sun Hong-tao, Xu Ji-guang, Yang Gang, Huo Lei-ming, Zhang Pan, Tian Jin-hui, Yang Ke-hu
机构信息
Department of Neurosurgery, First Clinical Medical College of Lanzhou University, Lanzhou 730000, China; Evidence-Based Medicine Center of Lanzhou University, Lanzhou 730000, China; Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
Department of Neurosurgery, Affiliated Hospital, Medical College of Chinese People's Armed Police, Tianjin 300162, China.
出版信息
Biomed Res Int. 2016;2016:5807346. doi: 10.1155/2016/5807346. Epub 2016 Feb 24.
BACKGROUND
To comprehensively assess the efficacy and safety of whole-brain radiotherapy (WBRT) combined with gefitinib/erlotinib for treatment of brain metastases (BM) from non-small-cell lung cancer (NSCLC).
METHODS
Databases including PubMed, EMBASE.com, Web of Science, and Cochrane Library were searched from inception to April 12, 2015. Studies on randomized controlled trials (RCTs) and case-control trials comparing WBRT combined with gefitinib/erlotinib versus WBRT alone for BM from NSCLC were included. Literature selection, data extraction, and quality assessment were performed independently by two trained reviewers. RevMan 5.3 software was used to analyze data.
RESULTS
A total of 7 trials involving 622 patients were included. Compared with WBRT alone or WBRT plus chemotherapy, WBRT plus gefitinib/erlotinib could significantly improve response rate (OR = 2.16, 95% CI: 1.35-3.47; P = 0.001), remission rate of central nervous system (OR = 6.06, 95% CI: 2.57-14.29; P < 0.0001), disease control rate (OR = 3.34, 95% CI: 1.84-6.07; P < 0.0001), overall survival (HR = 0.72, 95% CI: 0.58-0.89; P = 0.002), and 1-year survival rate (OR = 2.43, 95% CI: 1.51-3.91; P = 0.0002). In adverse events (III-IV), statistically significant differences were not found, except for rash (OR = 7.96, 95% CI: 2.02-31.34; P = 0.003) and myelosuppression (OR = 0.19, 95% CI: 0.07-0.51; P = 0.0010).
CONCLUSIONS
WBRT plus gefitinib/erlotinib was superior to WBRT alone and well tolerated in patients with BM from NSCLC.
背景
全面评估全脑放疗（WBRT）联合吉非替尼/厄洛替尼治疗非小细胞肺癌（NSCLC）脑转移（BM）的疗效和安全性。
方法
检索包括PubMed、EMBASE.com、Web of Science和Cochrane图书馆在内的数据库，检索时间从建库至2015年4月12日。纳入比较WBRT联合吉非替尼/厄洛替尼与单纯WBRT治疗NSCLC脑转移的随机对照试验（RCT）和病例对照试验。由两名经过培训的审阅者独立进行文献筛选、数据提取和质量评估。使用RevMan 5.3软件进行数据分析。
结果
共纳入7项试验，涉及622例患者。与单纯WBRT或WBRT加化疗相比，WBRT联合吉非替尼/厄洛替尼可显著提高缓解率（OR = 2.16，95%CI：1.35 - 3.47；P = 0.001）、中枢神经系统缓解率（OR = 6.06，95%CI：2.57 - 14.29；P < 0.0001）、疾病控制率（OR = 3.34，95%CI：1.84 - 6.07；P < 0.0001）、总生存期（HR = 0.72，95%CI：0.58 - 0.89；P = 0.002）和1年生存率（OR = 2.43，95%CI：1.51 - 3.91；P = 0.0002）。在不良事件（III - IV级）方面，除皮疹（OR = 7.96，95%CI：2.02 - 31.34；P = 0.003）和骨髓抑制（OR = 0.19，95%CI：0.07 - 0.51；P = 0.0010）外，未发现统计学显著差异。
结论
对于NSCLC脑转移患者，WBRT联合吉非替尼/厄洛替尼优于单纯WBRT，且耐受性良好。
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