国际肿瘤学杂志

国际肿瘤学杂志 ›› 2013, Vol. 40 ›› Issue (5): 384-388.

• 论著 • 上一篇    下一篇

调强适形放疗治疗鼻咽癌的系统评价

张质钢, 张秋宁, 王道英, 王小虎   

  1. 730000兰州大学循证医学中心兰州大学第一临床医学院（张质钢、王道英）；甘肃省肿瘤医院放疗科（张秋宁、王小虎）
  • 出版日期:2013-05-08 发布日期:2013-05-15
  • 通讯作者: 王小虎 E-mail:xhwanggs@yahoo.com.cn
  • 基金资助:

    甘肃省第八批科技计划（098TTC009）

Intensity-modulated radiotherapy for nasopharyngeal neoplasm: a systematic review

ZHANG  Zhi-Gang, ZHANG  Qiu-Ning, WANG  Dao-Ying, WANG  Xiao-Hu   

  1. Evidence Based Medicine Center of Lanzhou University, First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
  • Online:2013-05-08 Published:2013-05-15
  • Contact: WANG Xiao-hu E-mail:xhwanggs@yahoo.com.cn

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1368

被引次数

6

摘要： 目的评价调强适形放疗治疗鼻咽癌的有效性和安全性。方法计算机检索Cochrane Library、PubMed、EMBASE、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、维普和万方数据库，检索时间从建库至2012年6月15日，同时辅助其他检索。纳入调强适形放疗与常规放疗对比治疗鼻咽癌的随机对照试验（RCT）。两位研究者独立评价纳入研究的质量及提取资料，并用RevMan5.1软件进行统计分析。结果共纳入15个RCT，结果显示：与常规放疗相比，调强适形放疗可提高放疗后刺激性全唾液流量率、刺激性腮腺唾液流量率；显著减少急性期口干（RR=0.46，P<0.000 1）、黏膜反应（RR=0.86，P=0.04）、皮肤反应（RR=0.33，P<0.000 1）以及远期口干（RR=0.28，P=0.01）、张口受限（RR=0.42，P=0.008）等并发症，并有提高近期疗效（RR=1.22，P=0.02）和远期疗效（RR=1.25, P=0.04）的趋势。此外，调强放疗可能缩短治疗时间，但同时增加治疗费用。结论与常规放疗相比，调强适形放疗治疗鼻咽癌可保护唾液腺功能，减轻口干等并发症，并具有提高疗效的趋势。但纳入研究数及总样本量较小，结论仍有待更多高质量RCT明确。

关键词: 放射疗法, 调强适形, 鼻咽肿瘤, Meta分析

Abstract: Objective  To assess the efficacy and safety of intensity-modulated radiation therapy (IMRT) for nasopharyngeal neoplasm. Methods PubMed, EMBASE, Cochrane Library, CBM, CNKI, VIP and WanFang Data were fully searched up from creating database to June 15, 2012. Randomized controlled trials (RCTs) of IMRT versus conventional radiotherapy (CRT) for nasopharyngeal neoplasm were included. The quality of included studies was evaluated by two individual researchers and data were analyzed by using RevMan 5.1 software. Results  Fifteen RCTs were included. Meta-analyses suggested that patients treated by IMRT had a higher fractional stimulated parotid salivary flow rate and a higher stimulated whole salivary flow rate than CRT. IMRT can significantly reduce the acute xerostomia (RR=0.46, P<0.000 1),reaction of mucosa (RR=0.86, P=0.04), reaction of skin(RR=0.33, P<0.000 1), long-dated xerostomia (RR=0.28, P=0.01) and limitation of mouth opening (RR=0.42, P=0.008). And IMRT trended to improve short-term efficacy(RR=1.22, P=0.02) and long-term survival (RR=1.25, P=0.04). Moreover, IMRT trended to shorten the treatment time while increasing the costs. Conclusion  Compared with CRT, IMRT trends to be superior for nasopharyngeal neoplasm.However, because of small sample size, the results need to be proved by more clinical trials.

Key words: Radiotherapy, intensity-modulated, Nasopharyngeal neoplasms, Meta-analysis