Background: The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompre...Background: The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompressive surgery. Methods: In this randomised, multi-institutional, non-blind- ed trial, we randomly assigned patients with spinal cord compression caused by metastatic cancer to either surgery followed by radiotherapy (n=50) or radiotherapy alone (n=51). Radiotherapy for both treatment groups was given in ten 3 Gy fractions. The primary endpoint was the ability to walk. Secondary endpoints were urinary continence, muscle strength and functional status, the need for corticosteroids and opioid analgesics, and survival time. All analyses were by intention to treat. Findings: After an interim analysis the study was stopped because the criterion of a predetermined early stopping rule was met. Thus, 123 patients were assessed for eligibility before the study closed and 101 were randomised. Significantly more patients in the surgery group (42/50, 84%) than in the radiotherapy group (29/51, 57%)-were able to walk after treatment (odds ratio 6.2 [95%CI 2.0-19.8] p=0.001). Patients treated with surgery also retained the ability to walk significantly longer than did those with radiotherapy alone (median 122 days vs 13 days, p=0.003). 32 patients entered the study unable to walk; significantly more patients in the surgery group regained the ability to walk than patients in the radiation group (10/16 [62%] vs 3/16 [19%], p=0.01). The need for corticosteroids and opioid analgesics was significantly reduced in the surgical group. Interpretation: Direct decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.展开更多
目的:系统评价外科手术与经肝动脉栓塞术(transarterial embolization,TAE)治疗肝血管瘤的临床效果及并发症情况。方法:检索数据库中关于外科手术对比TAE治疗肝血管瘤的临床对照研究文献,检索时限均自建库至2016年11月。2名研究员按照...目的:系统评价外科手术与经肝动脉栓塞术(transarterial embolization,TAE)治疗肝血管瘤的临床效果及并发症情况。方法:检索数据库中关于外科手术对比TAE治疗肝血管瘤的临床对照研究文献,检索时限均自建库至2016年11月。2名研究员按照纳入与排除标准独立筛选文献、提取资料并评价质量,采用Rev Man 5.3软件作统计学分析。结果:最终6篇文献纳入研究,总病例数521例,其中326例接受外科手术治疗,295例接受TAE治疗。Meta分析结果显示:外科手术组复发率低于TAE组(OR=0.02,95%CI:0~0.08,P<0.05);外科手术组平均手术时间长于TAE组(OR=1.25,95%CI:0.88~1.62,P<0.05);外科手术组平均住院时间长于TAE组(OR=1.94,95%CI:1.50~2.39,P<0.05);外科手术组恢复正常工作时间长于TAE组(OR=1.18,95%CI:0.44~1.91,P=0.002);外科手术组平均住院费用(OR=0.25,95%CI:-1.04~1.53,P=0.71)和术后并发症发生率(OR=3.42,95%CI:0.96~12.25,P=0.06)与TAE组无明显差异。结论:外科手术和TAE均是治疗肝血管瘤的安全有效方式。外科手术治疗肝血管瘤复发率低,但手术时间、住院时间及恢复正常工作时间较长,两种治疗方式的近期并发症与治疗费用无显著差别。因此治疗方案的选择要结合上述因素综合考量。展开更多
文摘Background: The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompressive surgery. Methods: In this randomised, multi-institutional, non-blind- ed trial, we randomly assigned patients with spinal cord compression caused by metastatic cancer to either surgery followed by radiotherapy (n=50) or radiotherapy alone (n=51). Radiotherapy for both treatment groups was given in ten 3 Gy fractions. The primary endpoint was the ability to walk. Secondary endpoints were urinary continence, muscle strength and functional status, the need for corticosteroids and opioid analgesics, and survival time. All analyses were by intention to treat. Findings: After an interim analysis the study was stopped because the criterion of a predetermined early stopping rule was met. Thus, 123 patients were assessed for eligibility before the study closed and 101 were randomised. Significantly more patients in the surgery group (42/50, 84%) than in the radiotherapy group (29/51, 57%)-were able to walk after treatment (odds ratio 6.2 [95%CI 2.0-19.8] p=0.001). Patients treated with surgery also retained the ability to walk significantly longer than did those with radiotherapy alone (median 122 days vs 13 days, p=0.003). 32 patients entered the study unable to walk; significantly more patients in the surgery group regained the ability to walk than patients in the radiation group (10/16 [62%] vs 3/16 [19%], p=0.01). The need for corticosteroids and opioid analgesics was significantly reduced in the surgical group. Interpretation: Direct decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.
文摘目的:系统评价外科手术与经肝动脉栓塞术(transarterial embolization,TAE)治疗肝血管瘤的临床效果及并发症情况。方法:检索数据库中关于外科手术对比TAE治疗肝血管瘤的临床对照研究文献,检索时限均自建库至2016年11月。2名研究员按照纳入与排除标准独立筛选文献、提取资料并评价质量,采用Rev Man 5.3软件作统计学分析。结果:最终6篇文献纳入研究,总病例数521例,其中326例接受外科手术治疗,295例接受TAE治疗。Meta分析结果显示:外科手术组复发率低于TAE组(OR=0.02,95%CI:0~0.08,P<0.05);外科手术组平均手术时间长于TAE组(OR=1.25,95%CI:0.88~1.62,P<0.05);外科手术组平均住院时间长于TAE组(OR=1.94,95%CI:1.50~2.39,P<0.05);外科手术组恢复正常工作时间长于TAE组(OR=1.18,95%CI:0.44~1.91,P=0.002);外科手术组平均住院费用(OR=0.25,95%CI:-1.04~1.53,P=0.71)和术后并发症发生率(OR=3.42,95%CI:0.96~12.25,P=0.06)与TAE组无明显差异。结论:外科手术和TAE均是治疗肝血管瘤的安全有效方式。外科手术治疗肝血管瘤复发率低,但手术时间、住院时间及恢复正常工作时间较长,两种治疗方式的近期并发症与治疗费用无显著差别。因此治疗方案的选择要结合上述因素综合考量。
