放疗联合替莫唑胺治疗恶性脑胶质瘤疗效及安全性的系统评价

Effectiveness and safety of postoperative radiotherapy plus temozolomide for treating brain malignant glioma ：a systematic review

摘要:

目的：对近三年国内外关于术后放疗（radiotherapy，RT）联合替莫唑胺（temozolomide，TMZ）治疗恶性脑胶质瘤的疗效与安全性进行系统回顾和Meta分析。方法：计算机检索The Cochrane library、PubMed数据库、Elsevier光盘数据库、EBSCO检索平台、中国生物医学文献数据库、中国期刊全文数据库、万方数字化期刊全文库，查找2011年01月至2014年07月有关术后RT联合TMZ治疗恶性脑胶质瘤的随机对照试验（randomized controlled trials，RCTs），按Cochrane系统评价的方法评价所纳入研究，对同质研究采用RevMan 5.1进行Meta分析，对数据不能合并者，则进行描述性的定性分析。结果：本研究共纳入11例RCTs进行Meta分析，包括590例患者（实验组298例，对照组292例）。Meta分析结果显示，恶性胶质瘤术后RT联合TMZ化疗组与单纯术后RT组比较，其总有效率（RR=1.77，95%CI=1.45~2.15，P=0.000）和1年生存率（RR=1.38，95%CI=1.22~1.57，P=0.000）、2年生存率（RR=1.91，95%CI=1.46~2.51，P=0.000），3年生存率（RR=2.51，95%CI=1.40~4.48，P=0.002）差异均有统计学意义，比较常见不良反应，差异无统计学意义。结论：基于当前临床证据，术后RT联合TMZ化疗较单纯RT治疗恶性脑胶质瘤，其总有效率及1、2、3年生存率均明显上升，具有重要临床意义。

Abstract:

Objective：To systematically review and analyze the effectiveness and safety of postoperative radiotherapy plus temozolo－mide for malignant glioma. Methods：A systematic literature retrieval was conducted in the Cochrane library，PubMed，Elsevier，EB－SCO，CBM，CNKI and Wanfangdata from 2011 to 2014 according to designed searching strategy and relevant words. Published ran－domized-controlled clinical trials（RCTs） concerning the postoperative radiotherapy plus temozolomide for malignant glioma were en－rolled. The quality of the included RCTs was analyzed using Cochrane systematic evaluation. Homogenous studies were analyzed using Cochrane Collaboration’s RevMan 5.0 software and the studies in which the data were unable to be merged were analyzed by de－scriptive qualitative analysis. Results：A total of 11 RCTs involving 590 patients（experimental group：298 patients；control group：292 patients） were included. Significant differences were found in the total effective rate（RR=1.77，95%CI=1.45 to 2.15，P=0.000），1-year survival rate（RR=1.38，95%CI=1.22 to 1.57，P=0.000），2-year survival rate（RR=1.91，95%CI=1.46 to 2.51，P=0.000），3-year survival rate（RR=2.51，95%CI=1.40 to 4.48，P=0.002） between postoperative radiotherapy plus temozolomide and postoperative ra－diotherapy alone. There was no statistical difference in adverse reaction between the two groups. Conclusion：Based on current clini－cal evidence，treatment of malignant glioma with postoperative radiotherapy plus temozolomide can improve effective rate and 1-，2-，3-year survival rates.