Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
Radiother Oncol. 2017 Mar;122(3):332-339. doi: 10.1016/j.radonc.2016.12.034. Epub 2017 Jan 16.
The management of dysphagia owing to esophageal cancer is challenging. Brachytherapy has been proposed as an alternative option to stent placement. We performed a systematic review to examine its efficacy and safety in the resolution of dysphagia.
Prospective studies recruiting at least 20 patients with malignant dysphagia and published up to April 2016 were eligible. The dysphagia-free survival (DFS) and adverse event rates were pooled by means of a random effect model.
Six studies for a total of 9 treatment arms (623 patients) were eligible for inclusion. After 1month since treatment, the DFS rate was 86.9% [95%CI: 76.0-93.3%]; after 3months, it was 67.2% [95%CI: 56.1-76.7%]; after 6months, it was 47.4% [95%CI: 38.5-56.5%]; after 9months, it was 37.6% [95%CI:30.0-45.9%]; and, finally, after 12months, it was 29.4% [95%CI: 21.6-38.7%]. The heterogeneity between studies was high at 1-, 3- and 6-month assessment; the values of I were 86.3%, 80.0% and 57.8%, respectively. The meta-regression analysis showed total radiation dose and number of fractions as the only positively influencing factors. Severe adverse event rate was 22.6% (95%CI 19.4-26.3). The main reported adverse events were brachytherapy-related stenosis (12.2%) and fistula development (8.3%). Two cases (0.3%) of deaths were reported due to esophageal perforation.
Brachytherapy is a highly effective and relatively safe treatment option therefore its underuse is no longer justified. Further studies should investigate the optimal radiation dose and number of fractions able to achieve the highest DFS rates.
食管癌所致吞咽困难的治疗颇具挑战性。近距离放疗已被提议作为支架置入的替代方案。我们进行了一项系统评价，以评估其在缓解吞咽困难方面的疗效和安全性。
前瞻性研究，至少纳入 20 例恶性吞咽困难患者，且研究截止日期为 2016 年 4 月前，均符合入组条件。通过随机效应模型对无吞咽困难生存（DFS）率和不良事件发生率进行汇总。
共有 6 项研究，共计 9 个治疗臂（623 例患者）符合纳入标准。治疗后 1 个月，DFS 率为 86.9%（95%CI：76.0-93.3%）；3 个月时为 67.2%（95%CI：56.1-76.7%）；6 个月时为 47.4%（95%CI：38.5-56.5%）；9 个月时为 37.6%（95%CI：30.0-45.9%）；12 个月时为 29.4%（95%CI：21.6-38.7%）。研究间异质性在 1、3 和 6 个月评估时较高，I 值分别为 86.3%、80.0%和 57.8%。meta 回归分析显示，总辐射剂量和分割次数是唯一的正影响因素。严重不良事件发生率为 22.6%（95%CI：19.4-26.3%）。主要报告的不良事件为近距离放疗相关狭窄（12.2%）和瘘管形成（8.3%）。2 例（0.3%）患者因食管穿孔死亡。
近距离放疗是一种高效且相对安全的治疗选择，因此不再有理由不使用。进一步的研究应探讨能够实现最高 DFS 率的最佳辐射剂量和分割次数。
