CAJ | 학술논문

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)和长期疗效(RR=l.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.
목적 평개조강괄형방료치료비인암적유효성화안전성.방법 계산궤검색Cochrane Library、PubMed、EMBASE、중국생물의학문헌수거고(CBM)、중국기간전문수거고(CNKI)、유보화만방수거고,검색시간종건고지2012년6월15일,동시보조기타검색.납입조강괄형방료여상규방료대비치료비인암적수궤대조시험(RCT).량위연구자독립평개납입연구적질량급제취자료,병용RevMan5.1연건진행통계분석.결과 공납입15개RCT,결과현시:여상규방료상비,조강괄형방료가제고방료후자격성전타액류량솔、자격성시선타액류량솔；현저감소급성기구간(RR=0.46,P＜0.000 1)、점막반응(RR =0.86,P=0.04)、피부반응(RR =0.33,P＜0.000 1)이급원기구간(RR =0.28,P=0.01)、장구수한(RR =0.42,P=0.008)등병발증,병유제고근기료효(RR=1.22,P=0.02)화장기료효(RR=l.25,P =0.04)적추세.차외,조강방료가능축단치료시간,단동시증가치료비용.결론 여상규방료상비,조강괄형방료치료비인암가보호타액선공능,감경구간등병발증,병구유제고료효적추세.단납입연구수급총양본량교소,결론잉유대경다고질량RCT명학.
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.g6,P =0.04),reaction of skin (RR =0.33,P ＜ O.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.