Haven Hospice, Gainesville, OH, USA.
Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
Radiother Oncol. 2018 Mar;126(3):547-557. doi: 10.1016/j.radonc.2018.01.003. Epub 2018 Feb 1.
Radiation therapy is an effective modality for pain management of symptomatic bone metastases. We update the previous meta-analyses of randomized trials comparing single fraction to multiple fractions of radiation therapy in patients with uncomplicated bone metastases.
A literature search was conducted in Ovid Medline, Embase, and Cochrane Central Register. Ten new randomized trials were identified since 2010, five with adequate and appropriate data for inclusion, resulting in a total of 29 trials that were analyzed. Forest plots based on each study's odds ratios were computed using a random effects model and the Mantel-Haenszel statistic.
In intention-to-treat analysis, the overall response rate was similar in patients for single fraction treatments (61%; 1867/3059) and those for multiple fraction treatments (62%; 1890/3040). Similarly, complete response rates were nearly identical in both groups (23% vs 24%, respectively). Re-treatment was significantly more frequent in the single fraction treatment arm, with 20% receiving additional treatment to the same site versus 8% in the multiple fraction treatment arm (p < 0.01). No significant difference was seen in the risk of pathological fracture at the treatment site, rate of spinal cord compression at the index site, or in the rate of acute toxicity.
Single fraction and multiple fraction radiation treatment regimens continue to demonstrate similar outcomes in pain control and toxicities, but re-treatment is more common for single fraction treatment patients.
放射治疗是治疗症状性骨转移疼痛的有效方法。我们更新了之前比较单纯性骨转移患者单次与多次放射治疗的随机试验的荟萃分析。
在 Ovid Medline、Embase 和 Cochrane 中心注册库中进行文献检索。自 2010 年以来，发现了 10 项新的随机试验，其中 5 项具有足够和适当的数据纳入，总共分析了 29 项试验。使用随机效应模型和 Mantel-Haenszel 统计量计算基于每项研究的比值比的森林图。
在意向治疗分析中，单次治疗组（61%，1867/3059）和多次治疗组（62%，1890/3040）的总体缓解率相似。同样，两组的完全缓解率也非常相似（分别为 23%和 24%）。单次治疗组的再次治疗频率明显更高，有 20%的患者在同一部位接受额外治疗，而多次治疗组为 8%（p<0.01）。在治疗部位病理性骨折的风险、指数部位脊髓压迫的发生率或急性毒性的发生率方面，没有观察到显著差异。
单次和多次放射治疗方案在疼痛控制和毒性方面继续表现出相似的结果，但单次治疗患者的再次治疗更为常见。
