CAJ | 학술논문

目的系统评价预防性全脑照射(PCI)对非小细胞肺癌(NSCLC)的有效性和安全性.方法计算机检索Cochrane图书馆、MEDLINE、EMbase、中国生物医学文献数据库、中国期刊全文数据库和万方数据库,收集PCI治疗NSCLC的随机对照试验,由2名评价员按照纳入与排除标准选择文献、评价质量和提取资料,对符合纳入标准的研究用RevMan 5.1软件进行荟萃分析.结果共纳入4个随机对照试验共905例患者.与对照组(467例)相比,PCI组(438例)能减低脑转移率(x2=1.98,P =0.000),但不延长1年总生存率(x2=1.12,P=0.880).仪RTOG 2009 一项试验对PCI相关不良反应及生活质量进行了较详实评价:简易精神状态检查(P=0.600)、日常生活能力量表(P=0.880)两组相似；1年时霍普金斯语言学习测验即时记忆(P=0.030)和延迟记忆(P=0.008) PCI组均下降.随访至1年时PCI组与对照组的生活质量相似(P=0.050).结论 PCI能减低NSCLC患者的脑转移率但并未延长总生存,尚需进一步临床试验证实.
목적 계통평개예방성전뇌조사(PCI)대비소세포폐암(NSCLC)적유효성화안전성.방법 계산궤검색Cochrane도서관、MEDLINE、EMbase、중국생물의학문헌수거고、중국기간전문수거고화만방수거고,수집PCI치료NSCLC적수궤대조시험,유2명평개원안조납입여배제표준선택문헌、평개질량화제취자료,대부합납입표준적연구용RevMan 5.1연건진행회췌분석.결과 공납입4개수궤대조시험공905례환자.여대조조(467례)상비,PCI조(438례)능감저뇌전이솔(x2=1.98,P =0.000),단불연장1년총생존솔(x2=1.12,P=0.880).의RTOG 2009 일항시험대PCI상관불량반응급생활질량진행료교상실평개:간역정신상태검사(P=0.600)、일상생활능역량표(P=0.880)량조상사；1년시곽보금사어언학습측험즉시기억(P=0.030)화연지기억(P=0.008) PCI조균하강.수방지1년시PCI조여대조조적생활질량상사(P=0.050).결론 PCI능감저NSCLC환자적뇌전이솔단병미연장총생존,상수진일보림상시험증실.
Objective To determine whether prophylactic cranial irradiation (PCI) has a role in the management of patients with non-small cell lung carcinoma (NSCLC) treated with radical intent.Methods We searched The Cochrane Library,MEDLINE,EMbase,CBM,CNKI and VIP.The quality of the included studies was critically evaluated.Data analyses were performed using the Cochrane Collaboration's RevMan 5.1 software.Results Four randomized controlled trials involving 905 patients met the inclusion criteria.The results meta-analyses showed the incidence of brain metastases was lower in PCI group compared with the observation group ( x2 =1.98,P =0.000 ) ; but there is no evidence of 1-year overall survival (OS) benefit ( x2 =1.12,P =0.880).Only RTOG 2009 provides prospective data:There were no significant differences in global cognitive function (P =0.600) or ADL ( P =0.880) after PCI,but there was a significant decline in immediate recall (P=0.030) and delayed recall (P =0.008 ) at 1 year,At 1 year,there was no significant differences in QOL after PCI ( P =0.050).Conclusions This systematic review show significantly decreases the risk of BM without improving 1-year OS in NSCLC patient receiving prophylactic cranial irradiation.There is insufficient evidence to support the use of PCI in clinical practice.Where possible,patients should be offered entry into a clinical trial.