Viani Gustavo Arruda, Arruda Caio Viani, Hamamura Ana Carolina, Faustino Alexandre Ciufi, Danelichen Anielle Freitas Bendo, Matsuura Fernando Kojo, Neves Leonardo Vicente Fay
Faculdade de Medicina de Ribeirao Preto (FMRP), Universidade de Sao Paulo, Ribeirao Preto, SP, BR.
Instituto de Biociencias, Universidade Estadual Paulista (UNESP), Botucatu, SP, BR.
Clinics (Sao Paulo). 2020;75:e1644. doi: 10.6061/clinics/2020/e1644. Epub 2020 Sep 2.
The aim of this study was to evaluate whether there is a relationship between bleeding response and radiotherapy dose to palliate patients with local recurrence or progression of gastric cancer (GC). To this end, we conducted a systematic review and meta-analysis of observational studies that evaluated the bleeding response in patients with GC with local recurrence or progression. A meta-regression analysis between biological effective dose (BED) and bleeding response was performed, as was subgroup analysis to evaluate the outcome by BED level and radiotherapy (RT) technique. A p-value <0.05 was considered significant. Ten non-comparative retrospective studies and one prospective study were included. In general, RT was effective at controlling tumor bleeding, and the bleeding response rate was 0.77 (95% confidence interval (CI), 0.73-0.81). Meta-regression analysis demonstrated a linear correlation between BED Gy 10 and bleeding response (p=0<0001). Studies using conformational RT had a significant bleeding response rate compared to those using 2D (0.79; 95%CI, 0.74-0.84 vs 0.65; 95%CI, 0.56-0.75; p=0.021). In terms of the BED level, a significant difference in BR was identified on comparing BED Gy10 ≥40 (0.79; 95%CI, 0.7-0.8), BED Gy10 30-39 (0.79, 95%CI, 0.71-0.86), and BED Gy10 <30 (0.64; 95%CI, 0.5-0.7; p=0.0001). The mean survival time was 3.31 months (95%CI, 2.73-3.9) months, and the responders had a significantly longer survival (longer by 2.5 months) compared to the non-responders (95%CI, 1.7-3.3; p<0.0001). Palliative RT is effective at controlling bleeding due to local recurrence/progression from GC. Our findings reveal a relationship between BR and BED. BED <30 Gy 10 should not be recommended, and 3DRT should be indicated instead in order to improve the result.
本研究的目的是评估胃癌（GC）局部复发或进展患者的出血反应与放疗剂量之间是否存在关联。为此，我们对评估GC局部复发或进展患者出血反应的观察性研究进行了系统评价和荟萃分析。进行了生物等效剂量（BED）与出血反应之间的meta回归分析，以及按BED水平和放疗（RT）技术评估结果的亚组分析。p值<0.05被认为具有统计学意义。纳入了10项非对照回顾性研究和1项前瞻性研究。总体而言，放疗在控制肿瘤出血方面有效，出血反应率为0.77（95%置信区间（CI），0.73 - 0.81）。meta回归分析表明BED Gy 10与出血反应之间存在线性相关性（p = 0<0001）。与使用二维放疗的研究相比，使用适形放疗的研究出血反应率显著更高（0.79；95%CI，0.74 - 0.84 vs 0.65；95%CI，0.56 - 0.75；p = 0.021）。就BED水平而言，比较BED Gy10≥40（0.79；95%CI，0.7 - 0.8）、BED Gy10 30 - 39（0.79，95%CI，0.71 - 0.86）和BED Gy10<30（0.64；95%CI，0.5 - 0.7；p = 0.0001）时，出血反应（BR）存在显著差异。平均生存时间为3.31个月（95%CI，2.73 - 3.9个月），与无反应者相比，有反应者的生存期显著更长（长2.5个月）（95%CI，1.7 - 3.3；p<0.0001）。姑息性放疗在控制GC局部复发/进展所致出血方面有效。我们的研究结果揭示了BR与BED之间的关系。不建议使用BED<30 Gy 10，而应采用三维适形放疗（3DRT）以改善结果。
