Centre for Reviews and Dissemination, University of York, York, UK.
Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK.
Cancer Med. 2020 Jul;9(14):4949-4961. doi: 10.1002/cam4.3110. Epub 2020 May 19.
Regular off-treatment imaging is often used to assess for recurrence of disease after childhood cancer treatment. It is unclear if this increases survival, or what burden surveillance places on patients, families, or health-care services. This systematic review examines the impact of routine surveillance imaging after treatment of pediatric extracranial solid tumors.
Collaborative patient and public involvement informed the design and interpretation of this work. Thirteen electronic databases, conference proceedings, and trial registries were searched alongside reference list checking and forward citation searching from 1990 onwards. Studies were screened and data were extracted by two researchers. Risk of bias was assessed using a modified ROBINS-I tool. Relevant outcomes were overall survival, psychological distress indicators, number of imaging tests, cost-effectiveness, and qualitative data regarding experiences of surveillance programs. PROSPERO (CRD42018103764).
Of 17 727 records identified, 55 studies of 10 207 patients were included. All studies used observational methods. Risk of bias for all except one study was moderate, serious, or critical. Data were too few to conduct meta-analysis; however, narrative synthesis was performed. Surveillance strategies varied, and poorly reported, involving many scans and substantial radiation exposure (eg, neuroblastoma, median 133.5 mSv). For most diseases, surveillance imaging was not associated with increased overall survival, with the probable exception of Wilms tumor. No qualitative or psychological distress data were identified.
At present, there is insufficient evidence to evaluate the effects of routine surveillance imaging on survival in most pediatric extracranial solid tumors. More high-quality data are required, preferably through randomized controlled trials with well-conducted qualitative elements.
儿童癌症治疗后，常采用定期治疗后影像学检查来评估疾病复发情况。目前尚不清楚这种方法是否能提高生存率，以及监测会给患者、家庭或医疗服务带来什么负担。本系统评价旨在调查儿童颅外实体瘤治疗后常规监测影像学的影响。
患者和公众参与合作，为这项工作的设计和解释提供了信息。自 1990 年以来，我们通过 13 个电子数据库、会议记录和试验登记处进行了搜索，并结合参考文献检查和引文追溯搜索。两名研究人员筛选了研究并提取了数据。采用改良的 ROBINS-I 工具评估偏倚风险。相关结局指标包括总生存率、心理困扰指标、影像学检查次数、成本效益，以及关于监测计划体验的定性数据。PROSPERO（CRD42018103764）。
共确定了 17727 条记录，纳入了 55 项涉及 10207 名患者的研究。所有研究均采用观察性方法。除了一项研究之外，所有研究的偏倚风险均为中度、严重或关键。由于数据太少，无法进行荟萃分析；然而，进行了叙述性综合。监测策略各不相同，且报告不完善，涉及大量扫描和大量辐射暴露（例如神经母细胞瘤，中位数为 133.5mSv）。对于大多数疾病，监测成像与总体生存率的提高无关，但可能除外肾母细胞瘤。未发现定性或心理困扰数据。
目前，尚无足够的证据评估常规监测成像对大多数儿童颅外实体瘤生存的影响。需要更多高质量的数据，最好通过具有良好实施定性部分的随机对照试验来获得。
