放疗联合热疗治疗直肠癌有效性及安全性的系统评价

Radiotherapy combined with thermotherapy for treating patients with rectal cancer：a systematic review

摘要:

目的：系统评价放疗联合热疗治疗直肠癌的有效性及安全性，为临床实践与研究提供参考。方法：计算机检索Cochrane Library、PubMed、EMBASE、Web of Science和中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普中文科技期刊数据库（VIP）、万方数字化期刊数据库（WanFang），同时辅以其他检索。收集有关热放联合疗法治疗直肠癌的随机对照试验（random－ized controlled trials， RCTs）。评价员按照研究计划书进行文献筛选和资料提取，并对纳入文献进行质量评价后，使用RevMan 5.3软件进行Meta分析。结果：共纳入8篇RCT（573例患者）。Meta分析结果显示：联合组的2、3、4年生存率、完全缓解率、总有效率及症状缓解率均明显好于单独放疗组，2组差异均有统计学意义（P＜0.05），其RR值和95%CI分别为（RR=1.50，95%CI=1.10~2.06）、（RR=1.77，95%CI=1.06~2.98）、（RR=1.82，95%CI=1.04~3.17）、（RR=2.55，95%CI=1.55~4.19）、（RR=1.62，95%CI=1.34~1.96）、（RR=1.18，95%CI=1.03~1.34）；热放联合组急性毒性反应的发生率低于单放组，但其差异无统计学意义（P=0.05），其RR值与95%CI为（RR=0.72，95%CI=0.51~1.00）。结论：相较于单独放疗，放疗联合热疗治疗直肠癌能提高患者远期生存率和近期疗效，而且并不增加毒副反应的发生率。但受纳入研究数量和质量的限制，上述结论仍有待更多大样本高质量的研究予以验证。

Abstract:

Objective：To systematically review the efficacy and safety of radiotherapy combined with hyperthermia（HRT） for rectal cancer，and to provide the reference for clinical practice and research. Methods：Foreign databases of Cochrane Library，PubMed，EMBASE，Web of Science and Chinese databases of CBM，CNKI，VIP and WanFang were searched with computer and other sources were also retrieved. All relevant randomized controlled trials（RCTs） were collected to compare HRT and radiotherapy alone（RT） for rectal cancer. After literature screening，data extraction and quality evaluation were performed by authors according to the protocal，the meta-analyses were conducted using the RevMan 5.3 software. Results：Eight RCTs were included with 573 patients involved. Meta-analysis showed：①The 2，3，4-year survival rate，complete response rate，total effective rate and symptoms improve rate were higher in HRT group than in RT group，with significant differences（P<0.05）. The RR value and 95%CI were （RR=1.50，95%CI=1.10 to 2.06），（RR=1.77，95%CI=1.06 to 2.98），（RR=1.82，95%CI=1.04 to 3.17），（RR=2.55，95%CI=1.55 to 4.19），（RR=1.62，95%CI=1.34 to 1.96），and（RR=1.18，95%CI=1.03 to 1.34），respectively. ②The incidences of acute toxicity was lower in HRT group than in RT group，without significant difference（P=0.05）. The RR value and 95%CI were （RR=0.72，95%CI=0.51 to 1.00）. Conclusion：Compared with radiotherapy alone，HRT can improve long-term survival rate and short-term curative effect，therefore，it is safe and feasible. However，due to the limited quantity and quality of the included studies，more high quality studies with large sample size and long-term follow-up are still needed to verify the above conclu－sion.