Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Radiation Oncology, Arao Municipal Hospital, Kumamoto, Japan.
Int J Radiat Oncol Biol Phys. 2023 Jul 15;116(4):739-746. doi: 10.1016/j.ijrobp.2023.01.050. Epub 2023 Feb 2.
Previous meta-analysis of conventional radiation therapy for painful bone metastases showed overall response (OR) rates of 72% to 75% (evaluable patients), 61% to 62% (intent-to-treat patients) for initial radiation therapy, and 68% for reirradiation (evaluable patients). However, the definition of pain response differed among the studies included. Hence, we conducted a systematic review and meta-analysis to determine the pain response rates assessed by the International Consensus Pain Response Endpoints (ICPRE) for both initial radiation therapy and reirradiation. The PubMed and Scopus databases were searched for articles published between 2002 and 2021. The inclusion criteria were (1) prospective studies or studies based on prospectively collected data and (2) studies in which pain response was assessed using ICPRE. Our primary outcomes of interest were the OR rates (sum of the complete and partial response rates) for both initial radiation therapy and reirradiation. Of the 6470 articles identified in our database search, 32 and 3 met the inclusion criteria for the analysis of initial radiation therapy and reirradiation, respectively. The OR rates of initial radiation therapy in evaluable patients (n = 4775) and intent-to-treat patients (n = 6775) were 60.4% (95% confidence interval [CI], 55.2-65.4) and 45.4% (95% CI, 38.7-52.4), respectively. The OR rates of reirradiation in evaluable patients (n = 733) and intent-to-treat patients (n = 1085) were 70.8% (95% CI, 15.7-96.9) and 62.2% (95% CI, 5.3-98.0), respectively. Subgroup analyses of initial radiation therapy including the comparison of randomized and nonrandomized studies showed no significant differences in any comparison, indicating similar response rates across different study designs. For initial radiation therapy, we determined the ICPRE-assessed response rates, which were lower than previously reported. The OR and complete response rates should be benchmarks for future randomized and nonrandomized studies. For reirradiation, the wide CIs demonstrate that the response rates based on ICPRE require further investigation.
先前针对常规放射疗法治疗骨转移疼痛的荟萃分析显示，初始放射疗法的总体缓解（OR）率在可评价患者中为 72%至 75%，在意向治疗患者中为 61%至 62%，而在再放疗中为 68%（可评价患者）。然而，纳入的研究中疼痛缓解的定义存在差异。因此，我们进行了系统评价和荟萃分析，以确定初始放射疗法和再放疗中使用国际共识疼痛缓解终点（ICPRE）评估的疼痛缓解率。在 2002 年至 2021 年期间，我们在 PubMed 和 Scopus 数据库中搜索了已发表的文章。纳入标准为：（1）前瞻性研究或基于前瞻性收集数据的研究；（2）使用 ICPRE 评估疼痛缓解的研究。我们感兴趣的主要结局是初始放射疗法和再放疗的 OR 率（完全缓解和部分缓解率之和）。在我们的数据库搜索中，共确定了 6470 篇文章，其中 32 篇和 3 篇分别符合初始放射疗法和再放疗分析的纳入标准。在可评价患者（n=4775）和意向治疗患者（n=6775）中，初始放射疗法的 OR 率分别为 60.4%（95%置信区间[CI]，55.2-65.4）和 45.4%（95% CI，38.7-52.4）。在可评价患者（n=733）和意向治疗患者（n=1085）中，再放疗的 OR 率分别为 70.8%（95% CI，15.7-96.9）和 62.2%（95% CI，5.3-98.0）。初始放射疗法的亚组分析包括随机和非随机研究的比较，结果表明在任何比较中均无显著差异，这表明不同研究设计下的缓解率相似。对于初始放射疗法，我们确定了 ICPRE 评估的缓解率，该缓解率低于先前的报告。OR 和完全缓解率应作为未来随机和非随机研究的基准。对于再放疗，由于 CI 较宽，表明基于 ICPRE 的缓解率需要进一步研究。
