CAJ | 학술논문

目的通过荟萃分析,探讨全脑放疗(WBRT)联合替莫唑胺(TMZ)治疗非小细胞肺癌(NSCLC)脑转移的疗效及安全性.方法通过Medline、EMBASE、Cochrane、CBM等数据库检索国内外文献截止日期为2011年12月31日相关文献.选择治疗组为WBRT+ TMZ、对照组为单纯WBRT的NSCLC脑转移的随机对照试验(RCT).由2位评价者分别按上述检索策略收集资料,按纳入标准入选,主要对客观缓解及不良反应进行荟萃分析,其次是总生存(0S).结果共纳入4个RCT.WBRT+ TMZ与单纯WBRT相比,前者客观缓解率是后者的1.55倍(P =0.003);在不良反应方面,胃肠道不良反应(恶心、呕吐)的发生率两组相当(P=O.14),而血液学不良反应(3/4度骨髓抑制)的发生率前者是后者的2.47倍(P=0.008);在远期疗效方面,两组间生存获益的可能性相当(P=0.69).结论现有证据提示对于NSCLC脑转移的治疗,WBRT+ TMZ与单纯WBRT相比,改善了客观缓解,但增加了血液学不良反应,未能将近期的局控获益转化为远期的生存获益.因此,对于WBRT+ TMZ治疗NSCLC脑转移的疗效和安全性,还需要进一步的大规模、高质量、前瞻性的Ⅲ期临床研究进行验证.
목적 통과회췌분석,탐토전뇌방료(WBRT)연합체막서알(TMZ)치료비소세포폐암(NSCLC)뇌전이적료효급안전성.방법 통과Medline、EMBASE、Cochrane、CBM등수거고검색국내외문헌절지일기위2011년12월31일상관문헌.선택치료조위WBRT+ TMZ、대조조위단순WBRT적NSCLC뇌전이적수궤대조시험(RCT).유2위평개자분별안상술검색책략수집자료,안납입표준입선,주요대객관완해급불량반응진행회췌분석,기차시총생존(0S).결과 공납입4개RCT.WBRT+ TMZ여단순WBRT상비,전자객관완해솔시후자적1.55배(P =0.003);재불량반응방면,위장도불량반응(악심、구토)적발생솔량조상당(P=O.14),이혈액학불량반응(3/4도골수억제)적발생솔전자시후자적2.47배(P=0.008);재원기료효방면,량조간생존획익적가능성상당(P=0.69).결론 현유증거제시대우NSCLC뇌전이적치료,WBRT+ TMZ여단순WBRT상비,개선료객관완해,단증가료혈액학불량반응,미능장근기적국공획익전화위원기적생존획익.인차,대우WBRT+ TMZ치료NSCLC뇌전이적료효화안전성,환수요진일보적대규모、고질량、전첨성적Ⅲ기림상연구진행험증.
Objective To explore the efficacy and safety of whole brain radiation therapy(WBRT)plus temozolomide(TMZ)versus WBRT alone in the treatment of brain metastases from non-small cell lung cancer(NSCLC)through a meta-analysis.Methods All previously published and some unpublished studies were comprehensively searched from the databases of MEDLINE,EMBASE,Cochrane Library and CBM,etc.The meta-analysis included all randomized controlled trials(RCTs)to compare WBRT plus TMZ with WBRT alone in treatment of brain metastases from NSCLC.The primary meta-analysis was based upon objective remission(OR)and toxicity and the second overall survival(OS).Results Four RCTs identified by two reviewers were included.There was significant improvement for the WBRT + TMZ group in OR rate (RR =1.55,P =0.003);but without significant improvement in OS(P =0.69).Meanwhile,WHO grade Ⅲ/Ⅳ hematologic toxicity of myelosuppression increased in the WBRT + TMZ group(RR =2.47,P =0.008),but without significant difference in gastrointestinal toxicity(P =0.14).Conclusions For the treatment of brain metastases from NSCLC,the combined therapy of WBRT plus TMZ improves OR,but without significant improvement in OS.And the incidence of myelosuppression is elevated.Future large-scale,high-quality and prospective phase Ⅲ RCTs are needed to confirm the clinical efficacy and safety of WBRT plus TMZ.