Bergamin Sarah, Tio Martin, Stevens Mark John
Northern Sydney Cancer Centre - Radiation Oncology Unit, Northern Sydney Cancer Centre, Level 1, Royal North Shore Hospital, Reserve Rd. St Leonards, NSW, 2065, Australia.
Northern Sydney Cancer Centre - Medical Oncology Unit, Northern Sydney Cancer Centre, Level 1, Royal North Shore Hospital, Reserve Rd. St Leonards, NSW, 2065 Australia.
Clin Transl Radiat Oncol. 2018 Sep 18;13:38-43. doi: 10.1016/j.ctro.2018.09.004. eCollection 2018 Nov.
Malignant pleural mesothelioma (MPM) is an aggressive cancer with a propensity for seeding procedure tracts, leading to symptomatic metastases. There is conflicting evidence on the value of prophylactic procedure tract radiotherapy in reducing tract metastases. We performed a systematic review and meta-analysis to estimate the benefit of radiotherapy in this setting.
Electronic databases were searched to January 1, 2018 for prospective randomized control trials with prophylactic procedure tract radiotherapy as the intervention arm. Pooled odds ratios and 95% confidence intervals were calculated using a random effects model. Study heterogeneity was assessed using the I2 statistic, and publication bias was evaluated by funnel plot and Egger's regression model.
Five studies were included for meta-analysis. Prophylactic radiotherapy did not have a statistically significant reduction on the risk of procedure site recurrence, with a pooled relative risk of 0.69 (95% CI 0.33-1.43). There was moderate heterogeneity between trials. All trials were assessed as moderate or high risk of bias overall.
This systematic review has confirmed that there is no role for prophylactic procedure tract radiotherapy in MPM. In the absence of effective prophylactic procedures, patients need to be monitored closely, and palliative interventions delivered in a timely manner to reduce morbidity associated with procedure tract metastases.
恶性胸膜间皮瘤（MPM）是一种侵袭性癌症，易于在手术切口处播散，导致有症状的转移。关于预防性手术切口放疗在减少切口转移方面的价值，证据存在冲突。我们进行了一项系统评价和荟萃分析，以评估在这种情况下放疗的益处。
检索电子数据库至2018年1月1日，查找以预防性手术切口放疗作为干预组的前瞻性随机对照试验。使用随机效应模型计算合并比值比和95%置信区间。使用I²统计量评估研究异质性，并通过漏斗图和Egger回归模型评估发表偏倚。
五项研究纳入荟萃分析。预防性放疗对手术部位复发风险没有统计学上的显著降低，合并相对风险为0.69（95%CI 0.33 - 1.43）。试验之间存在中度异质性。所有试验总体评估为中度或高度偏倚风险。
这项系统评价证实，预防性手术切口放疗在MPM中没有作用。在缺乏有效预防措施的情况下，需要密切监测患者，并及时进行姑息性干预，以降低与手术切口转移相关的发病率。
