食管鳞癌精准放疗技术下累及野照射与选择性淋巴引流区照射Meta分析

目的 进入三维适形/调强放射治疗时代,食管鳞癌患者行根治性放疗是否需要进行选择性淋巴引流区照射(elective nodal irradiation,END,或仅需累及野照射(involved field irradiation,IFI)仍存在争议,因此本研究应用Meta分析方法比较食管鳞癌三维适形/调强放射治疗采用IFI与ENI的疗效和毒副作用,为临床应用提供参考.方法 检索中国生物医学文献数据库、中国学术期刊全文数据库、Cochrane Library、PubMed和EMbase等国内外数据库有关食管鳞癌精准放射治疗条件下IFI与ENI对比的文献,末次检索时间2016-08 31.依据入选和排除标准,收集各项研究中有关临床疗效、毒副反应及失败模式,应用Meta分析方法比较IFI与ENI在临床治疗食管鳞癌患者中的优劣.结果 初检出文献63篇,剔除学位论文/会议投稿或非北大医学图书馆收录文献18篇.进一步阅读全文,排除数据重复发表文献20篇,采用二维技术2篇以及非病例对照研究14篇,最终纳入符合标准的国内外文献9篇.共包括1 143例患者,其中采用单纯放疗605例,放化综合治疗538例.结果显示,IFI组与ENI组相比1、2和3年局部控制率差异无统计学意义(OR=0.759,95％CI为0.572～1.008,P=0.057;OR=1.076,95％CI为0.790～1.466,P=0.641;OR=0.977,95％CI为0.726～1.315,P=0.879),1、2和3年OS差异无统计学意义(HR=0.824,95％CI为0.623～1.091,P=0.959;HR=1.030,95％CI为0.715～1.483,P=0.206;HR=0.846,95％CI为0.488～1.465,P=0.551),但≥3级放射性食管炎、≥3级放射性肺炎发生率累及野组明显降低(OR=0.515,95％CI为0.341～0.778,P=0.002;OR=0.481,95％CI为0.254～0.913,P=0.025).两组野外复发/转移率差异无统计学意义,OR=1.629,95％CI为0.708～3.747,p=0.251.结论 食管鳞癌精准照射条件下IFI组局部控制率、生存率与ENI组差异无统计学意义,而重度放射性食管炎和放射性肺炎的发生率明显降低,且IFI照射并不增加野外复发/转移几率.考虑到纳入文献大多为回顾性研究,因此尚需开展大宗的前瞻性随机对照研究进行验证.

Involved-field irradiation and elective nodal irradiation under precise radiotherapy in esophageal squamous cell carcinoma: A Meta analysis

OBJECTIVE In the era of 3D conformal/intensity-modulated radiation therapy,whether elective nodal irradiation (ENI) is required for radical radiotherapy in patients with esophageal squamous cell carcinoma,or only involved-field irradiation (IFI) is still controversial.In this study,we tried to compare the clinical effect and toxic side effect of IFI and ENI in the treatment of esophageal squamous cell carcinoma using Meta analysis,in order to provide reference for clinic use.METHODS Literatures about the comparison of IFI versus ENI were selected from Chinese biomedical literature database,CNKI,Cochrane library,Pubmed and EMbase.The last retrieval time was August 31,2016.According to the inclusion and exclusion criteria,clinical effect,side effect and failure modes were collected.A Meta analysis was performed to evaluate the advantages and disadvantages in the treatment of esophageal squamous cell carcinoma.RESULTS Initially,sixty-three literatures were collected,and then dissertations/conference contributions or not included in Peking university library (a total of 18 articles) were excluded.After reading full text,twenty literatures published with duplication data,two of using 2D technology,and fourteen of non case control study were removed.Eventually,a total of 9 studies including 1 143 patients were involved,of 605 cases underwent radiotherapy only,and 538 underwent radiochemotherapy.There was no significant difference in 1,2-,3 year local control rate between IFI and ENI (OR=0.759,95％CI:0.572-1.008,P=0.057;OR =1.076,95％CI:0.790-1.466,P=0.641;OR =0.977,95％CI:0.726-1.315,P=0.879),and 1,2,3-year overall survival rates were also not statistically different (HR=0.824,95％CI:0.623-1.091,P=0.959;HR=1.030,95％CI:0.715-1.483,P =0.206;HR =0.846,95％CI:0.488-1.465,P =0.551),but the incidences of ≥ 3 grade acute esophagitis and pneumonia were reduced significantly in IFIgroup (OR=0.515,95％CI:0.341-0.778,P =0.002;OR=0.481,95％CI:0.254-0.913,P =0.025).The rate of out-field recurrence/metastasis in the two groups had no difference (OR =1.629,95％CI:0.708-3.747,P=0.251).CONCLUSIONS There is no significant in local control rate and overall survival rate between IFI group and ENI group,but the incidences of severe radiation esophagitis and pneumonia decrease significantly in IFI group.IFI dose not increase the out-field recurrence/metastasis.Considering that most of the included studies are retrospective,it still needs to carry out a large prospective randomized study for verification.