胸部放疗在广泛期小细胞肺癌中的作用：一项系统评价和荟萃分析。
Role of thoracic radiotherapy in extensive stage small cell lung cancer: a systemic review and meta-analysis.
作者信息
Li Ao-Mei, Zhou Han, Xu Yang-Yang, Ji Xiao-Qin, Wu Tian-Cong, Yuan Xi, Jiang Chang-Chen, Zhu Xi-Xu, Zhan Ping, Shen Ze-Tian
机构信息
Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.
出版信息
Ann Transl Med. 2021 Feb;9(4):299. doi: 10.21037/atm-20-5765.
BACKGROUND
The role of thoracic consolidation radiotherapy in patients with extensive stage small cell lung cancer (ES-SCLC) remains controversial. This study aimed to evaluate the efficacy of thoracic radiotherapy (TRT) in these patients.
METHODS
A systematic literature search was performed in PubMed, Embase, and the Cochrane library to identify qualified clinical studies. The hazard ratios (HRs) and 95% confidence intervals (CIs) of overall survival (OS), progression-free survival (PFS) and local recurrence-free survival (LRFS) were extracted, and toxicity of the TRT group versus non-TRT group was analyzed.
RESULTS
A total of 12 studies were included in this meta-analysis, including 936 patients in the TRT group and 1,059 patients in the non-TRT group. The combined results showed that TRT significantly improved OS (HR =0.65; 95% CI: 0.55-0.77, P<0.00001), PFS (HR =0.64; 95% CI: 0.56-0.72, P<0.00001) and LRFS (HR =0.38, 95% CI: 0.26-0.53, P<0.00001). Subgroup analysis showed that OS benefits were observed in patients receiving sequential TRT (HR =0.67; 95% CI: 0.54-0.84, P=0.0006). The addition of TRT significantly improved OS in patients over 65 years of age (HR =0.55; 95% CI: 0.40-0.74, P=0.0001). For patients with only one organ metastasis, there was no significant difference in OS between the two groups (HR =0.61; 95% CI: 0.36-1.01, P=0.06). There was no statistical difference in hematologic toxicity (leukopenia, thrombocytopenia, anemia) and non-hematologic toxicity (nausea or vomiting) between the two groups. The incidence of grade ≥3 esophageal toxicity was 4.6% in the TRT group and 0% in the non-TRT group (P=0.0001). Grade ≥3 bronchopulmonary toxicity was 2.9% in the TRT group and 0.8% in the non-TRT group (P=0.02).
CONCLUSIONS
TRT improves OS, PFS and LRFS in patients with ES-SCLC, with a low increase in esophageal and bronchopulmonary toxicity. More randomized controlled trials (RCTs) are expected to confirm our conclusions.
PROSPERO REGISTRATION NUMBER
CRD42020190575.
背景
胸部巩固放疗在广泛期小细胞肺癌（ES-SCLC）患者中的作用仍存在争议。本研究旨在评估胸部放疗（TRT）在这些患者中的疗效。
方法
在PubMed、Embase和Cochrane图书馆进行系统文献检索，以确定合格的临床研究。提取总生存期（OS）、无进展生存期（PFS）和无局部复发生存期（LRFS）的风险比（HRs）及95%置信区间（CIs），并分析TRT组与非TRT组的毒性。
结果
本荟萃分析共纳入12项研究，TRT组936例患者，非TRT组1059例患者。综合结果显示，TRT显著改善了OS（HR =0.65；95% CI：0.55 - 0.77，P<0.00001）、PFS（HR =0.64；95% CI：0.56 - 0.72，P<0.00001）和LRFS（HR =0.38，95% CI：0.26 - 0.53，P<0.00001）。亚组分析显示，接受序贯TRT的患者OS有获益（HR =0.67；95% CI：0.54 - 0.84，P =0.0006）。TRT的加入显著改善了65岁以上患者的OS（HR =0.55；95% CI：0.40 - 0.74，P =0.0001）。对于仅有一种器官转移的患者，两组OS无显著差异（HR =0.61；95% CI：0.36 - 1.01，P =0.06）。两组在血液学毒性（白细胞减少、血小板减少、贫血）和非血液学毒性（恶心或呕吐）方面无统计学差异。TRT组≥3级食管毒性发生率为4.6%，非TRT组为0%（P =0.0001）。TRT组≥3级支气管肺毒性为2.9%，非TRT组为0.8%（P =0.02）。
结论
TRT可改善ES-SCLC患者的OS、PFS和LRFS，食管和支气管肺毒性增加较少。期待更多随机对照试验（RCT）来证实我们的结论。
PROSPERO注册号：CRD42020190575。
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