立体定向体部放疗治疗疼痛性骨转移瘤的疗效与安全性：来自随机对照试验的证据

Efficacy and safety of stereotactic body radiotherapy for painful bone metastases: Evidence from randomized controlled trials.

作者信息

Wang Zilan, Li Longyuan, Yang Xingyu, Teng Haiying, Wu Xiaoxiao, Chen Zhouqing, Wang Zhong, Chen Gang

机构信息

Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China.

Department of Suzhou Medical College, Soochow University, Suzhou, China.

出版信息

Front Oncol. 2022 Oct 19;12:979201. doi: 10.3389/fonc.2022.979201. eCollection 2022.

BACKGROUND

Pain relief is one of the main objectives of radiotherapy for cancer patients with bone metastases. Stereotactic body radiotherapy (SBRT) enables precise delivery of a higher dosage to the target area. Several trials have reported comparisons between SBRT and conventional radiotherapy (cRT) in patients with painful bone metastasis. However, the results of those investigations were inconsistent, and no systematic review or meta-analysis has been done till now.

METHODS

We systematically searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov up to May 1, 2022 for relevant studies. Patients with painful bone metastasis who received SBRT or cRT were included. The primary outcome was the patients' pain response rate at three months. The secondary outcomes included the rate of pain responders at one month and six months, oral morphine equivalent dose (OMED) use, and any adverse events. STATA software 12.0 was used for the statistical analysis.

RESULTS

We collected 533 patients' data from 4 randomized controlled trials (RCTs), there was a significant difference of pain response rate at 3 months between two groups (RR = 1.41, 95% CI: 1.12-1.77, = 0.0%, P = 0.003). However, no significant difference was found in pain response rate at 1 month (RR = 1.19, 95% CI: 0.91-1.54, = 31.5%, P = 0.201) and 6 months (RR = 1.25, 95% CI: 0.93-1.69, = 0.0%, P = 0.140). OMED consumption was not significantly different in patients treated with SBRT compared with control group (WMD = -1.11, 95% CI: -17.51-15.28, = 0.0%, P = 0.894). For safety outcome, no statistical difference was found between SBRT and cRT (RR = 0.72, 95% CI: 0.46-1.14, 20.1%, P = 0.162).

CONCLUSION

This study shows that for painful bone metastases, patients with SBRT experienced better pain relief 3 months after radiation than patients with cRT, and SBRT did not increase the incidence of adverse events.

SYSTEMATIC REVIEW REGISTRATION

https://inplasy.com/inplasy-2022-6-0099/, identifier INPLASY202260099.

背景

缓解疼痛是骨转移癌患者放射治疗的主要目标之一。立体定向体部放射治疗（SBRT）能够向靶区精确输送更高剂量的辐射。多项试验报告了SBRT与传统放射治疗（cRT）在疼痛性骨转移患者中的比较情况。然而，这些研究结果并不一致，目前尚未进行系统评价或荟萃分析。

方法

我们系统检索了截至2022年5月1日的MEDLINE、EMBASE、Cochrane对照试验中心注册库（CENTRAL）和Clinicaltrials.gov，以查找相关研究。纳入接受SBRT或cRT的疼痛性骨转移患者。主要结局是患者三个月时的疼痛缓解率。次要结局包括一个月和六个月时的疼痛缓解者比例、口服吗啡等效剂量（OMED）的使用情况以及任何不良事件。使用STATA软件12.0进行统计分析。

结果

我们从4项随机对照试验（RCT）中收集了533例患者的数据，两组之间三个月时的疼痛缓解率存在显著差异（RR = 1.41，95%CI：1.12 - 1.77，I² = 0.0%，P = 0.003）。然而，在一个月时（RR = 1.19，95%CI：0.91 - 1.54，I² = 31.5%，P = 0.201）和六个月时（RR = 1.25，95%CI：0.93 - 1.69，I² = 0.0%，P = 0.140）的疼痛缓解率未发现显著差异。与对照组相比，接受SBRT治疗的患者OMED消耗量无显著差异（WMD = -1.11，95%CI：-17.51 - 15.28，I² = 0.0%，P = 0.894）。对于安全性结局，SBRT与cRT之间未发现统计学差异（RR = 0.72，95%CI：0.46 - 1.14，I² = 20.1%，P = 0.162）。