摘要
目的 探讨全脑放疗（WBRT）和（或）立体定向放射治疗（SRT）联合第一代表皮生长因子受体酪氨酸激酶抑制剂（TKI）同期治疗非小细胞肺癌（NSC LC）脑转移的疗效及不良反应.方法 通过荟萃分析检索EMBASE、Medline、Cochrane图书馆等数据库,搜集国内外的相关文献.纳入治疗组为放疗联合TKI同期治疗、对照组为单纯放疗的NSCLC脑转移的前瞻性的随机对照试验（RCT）和非随机对照试验（non-RCT）,采用RevMan5.2软件进行荟萃分析.主要对客观缓解（OR）、疾病控制（DC）及不良反应进行分析,其次是总生存（OS）.结果 3个RCT和1个非随机对照试验纳入分析.总体结果表明,RT＋ TKI组与单纯RT组相比,前者的OR和DC率分别为后者的1.80倍（P＜0.01）和1.31倍（P＜0.01）;在治疗的不良反应方面,恶心、呕吐的发生率两组差异无统计学意义（P=0.20）,而皮疹和腹泻的发生率前者分别为后者的14.36倍（P=0.003）和3.49倍（P=0.005）;在长期疗效方面,前者的总生存获益情是后者的3.06倍（P =0.000 8）.结论 对于NSCLC脑转移的治疗,RT＋ TKI同期治疗与单纯RT相比,有可能提高OR和DC,延长总生存,但是增加皮疹和腹泻的发生率.
Objective To evaluate the efficacy of whole brain radiotherapy （WBRT） or/and stereotactic radiotherapy （SRT） concomitant with first-generation epidermal growth factor receptor tyrosine kinase inhibitors （TKI）,like erlotinib and gefitinib,in the treatment of brain metastases from non-small cell lung cancer （NSCLC）.Methods Comprehensive searches were performed in different databases,including EMBASE,MEDLINE and Cochrane Library,etc.All randomized controlled trials （RCTs） and nonrandomized controlled trials （non-RCTs） comparing radiotherapy （RT） plus TKI with RT alone in the treatment of brain metastases from NSCLC were included for meta-analysis with Cochrane Collaboration＆#39;s RevMan5.2 software.The primary end-points were objective remission （OR）,disease control （DC） and toxicity while the secondary end-point was overall survival （OS）.Results Three RCTs and one nonrandomized controlled trial were selected and included for final analysis.The RT ＋ TKI group had significant improvements in OR rate （RR =1.80,P 〈0.01） and DC rate （RR =1.31,P 〈0.01）.Meanwhile,rash （RR =14.36,P =0.003） and diarrhea （RR =3.49,P =0.005） increased in the RT ＋ TKI group.Yet there was no significant difference in nausea or vomiting （P =0.20）.Conclusion For NSCLC with brain metastases,RT plus TKI could improve OR,DC and OS,but there was a higher incidence of rash and diarrhea.There fore future high-quality and prospective RCTs are warranted to confirm the clinical efficacy of RT plus TKI in the treatment of NSCLC with brain metastases.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第5期386-391,共6页
National Medical Journal of China
关键词
癌
非小细胞肺
肿瘤转移
META分析
Carcinoma,non-small-cell lung
Neoplasm metastasis
Meta-analysis
