Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Dermatology, Venerology and Allergy, Division of Evidence-Based Medicine (dEBM), Berlin, Germany.
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Dermatology, Venerology and Allergy, Division of Evidence-Based Medicine (dEBM), Berlin, Germany.
Radiother Oncol. 2021 Apr;157:188-196. doi: 10.1016/j.radonc.2021.01.031. Epub 2021 Feb 4.
This systematic review summarised and critically appraised evidence on the efficacy and safety of interventions for anal cancer to support the panel of experts developing the national evidence-based anal cancer guideline in Germany.
We conducted a systematic review and meta-analyses of interventions for the treatment of stage I to III anal squamous cell carcinoma (SCCA). We systematically searched several databases and included any randomised controlled trial (RCT) assessing the pre-specified patient populations, regardless of the interventions studied. Non-randomised controlled studies of selected, pre-specified interventions were included if RCTs were not available or contained insufficient information. Where possible, we conducted meta-analyses and critically assessed confidence in the effect estimates using the GRADE approach.
Our searches yielded 10,325 (25 October 2018) and 889 hits (update search on 18 July 2019). Among the 41 studies (47 publications) included, we identified 19 comparisons of interventions for SCCA, and confidence in the effect estimates ranged from very low to high. Most RCTs compared various chemoradiation regimes. For other treatment options, such as local excision in early stages or different radiotherapies, we mostly identified comparative cohort studies.
Our findings indicate that, in most clinical situations, primary chemoradiation based on 5-FU and MMC is still the gold standard. However, treatment options for stage I anal cancer, particularly of the anal margin, as well as newer treatment approaches should be investigated in future RCTs. Overall, our findings may help health care professionals and patients make informed decisions about treatment choices.
本系统评价总结并批判性评估了干预措施治疗肛门癌的疗效和安全性证据，为德国制定国家循证肛门癌指南的专家组提供支持。
我们对治疗 I 期至 III 期肛门鳞癌（SCCA）的干预措施进行了系统评价和荟萃分析。我们系统地搜索了多个数据库，并纳入了评估特定患者人群的任何随机对照试验（RCT），无论所研究的干预措施如何。如果 RCT 不可用或包含的信息不足，则纳入选定的、特定干预措施的非随机对照研究。如果可能，我们进行了荟萃分析，并使用 GRADE 方法批判性地评估了对效应估计的信心。
我们的搜索结果为 10325 条（2018 年 10 月 25 日）和 889 条（2019 年 7 月 18 日更新搜索）。在纳入的 41 项研究（47 篇文献）中，我们确定了 19 项 SCCA 干预措施的比较，对效应估计的信心程度从极低到高不等。大多数 RCT 比较了各种放化疗方案。对于其他治疗选择，如早期局部切除或不同的放疗，我们主要发现了比较队列研究。
我们的研究结果表明，在大多数临床情况下，基于 5-FU 和 MMC 的初始放化疗仍然是金标准。然而，对于 I 期肛门癌的治疗选择，特别是肛门边缘的肿瘤，以及新的治疗方法，应该在未来的 RCT 中进行研究。总的来说，我们的研究结果可能有助于医疗保健专业人员和患者做出关于治疗选择的知情决策。
