Viani Gustavo Arruda, Pavoni Juliana Fernandes, De Fendi Ligia Issa
Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil.
Rep Pract Oncol Radiother. 2021 Apr 14;26(2):218-225. doi: 10.5603/RPOR.a2021.0031. eCollection 2021.
The aim of this study was to evaluate the effectiveness of prophylactic corticosteroids to prevent pain flare (PF) in bone metastases treated with radiotherapy performing a meta-analysis of randomized clinical trials (RCT).
RCTs were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through June 2020. We followed the PRISMA and MOOSE guidelines. A meta-analysis was performed to assess if corticosteroids reduce the PF, pain progression, and the mean of days with PF compared with the placebo. A p-value < 0.05 was considered significant.
Three RCTs with a total of 713 patients treated were included. The corticosteroids reduced the occurrence of early PF 20.5% (51/248) versus 32% (80/250) placebo, OR = 0.55 (95% CI: 0.36-0.82, p = 0.002). The mean days of PF were reduced to 1.6 days (95% CI: 1.3-1.9, p = 0.0001). Prophylactic corticosteroids had more patients with no PF and no pain progression, OR = 1.63 (95% CI: 1.14-2.32, p = 0.007). No significant corticosteroids effect was observed for pain progression (p = ns) and late PF occurrence (p = ns).
Prophylactic corticosteroids reduced the incidence of early PF, the days with PF, resulting in a superior rate of patients with no PF and no pain progression, but with no significant benefit for reducing pain progression or late PF occurrence.
本研究旨在通过对随机临床试验（RCT）进行荟萃分析，评估预防性使用皮质类固醇预防接受放射治疗的骨转移患者疼痛发作（PF）的有效性。
通过检索截至2020年6月的Medline、Embase、Cochrane图书馆以及年会论文集来识别随机临床试验。我们遵循PRISMA和MOOSE指南。进行荟萃分析以评估与安慰剂相比，皮质类固醇是否能减少PF、疼痛进展以及PF持续天数的均值。p值<0.05被认为具有统计学意义。
纳入了3项随机临床试验，共713例接受治疗的患者。皮质类固醇使早期PF的发生率降低，分别为20.5%（51/248）和安慰剂组的32%（80/250），OR = 0.55（95%CI：0.36 - 0.82，p = 0.002）。PF的平均天数降至1.6天（95%CI：1.3 - 1.9，p = 0.0001）。预防性使用皮质类固醇使无PF且无疼痛进展的患者更多，OR = 1.63（95%CI：1.14 - 2.32，p = 0.007）。未观察到皮质类固醇对疼痛进展（p = 无统计学意义）和晚期PF发生（p = 无统计学意义）有显著影响。
预防性使用皮质类固醇降低了早期PF的发生率、PF持续天数，使无PF且无疼痛进展的患者比例更高，但对减轻疼痛进展或晚期PF发生无显著益处。
