早期乳腺癌保乳术后大分割放疗的Meta分析

目的:评价早期乳腺癌保乳术后大分割放射治疗(HOFRT)的疗效及安全性。方法:计算机检索PubMed、Cochrane Library、SCI、EMBASE、中文科技期刊全文数据库、中国期刊全文数据库、数字化期刊全文数据库和中国生物医学文献数据库，并辅以手工检索和其他检索。纳入比较早期乳腺癌保乳术后大分割放疗与常规放射治疗(CRT)的临床对照试验，根据Cochrane系统评价手册5.0.0质量评价标准进行质量评价，使用RevMan5.2软件进行Meta分析。结果:共纳入5个研究(8010例)，Meta分析显示:与CRT相比，HOFRT后3年总生存率有差异［RR=1.03（95%CI:1.01-1.06）］，而5、10年总生存率方面无差异［RR=1.02（95%CI:0.99-1.06）、RR=1.02（95%CI:0.95-1.09）］；5年绝对美容满意率、无复发生存率及无病生存率方面无差异［RR=1.05（95%CI:0.95-1.16）、RR=0.97(95% CI:0.41-1.10)、RR=1.00(95%CI:0.95-1.05)］；5年局部复发率、腋窝及锁骨上窝复发率、对侧乳腺癌、第二肿瘤发生率及远处转移率无差异［RR=0.91(95%CI:0.69-1.19)、RR=0.87（95%CI:0.53-1.44)、RR=0.71(95%CI:0.43-1.15)、RR=0.87(95%CI:0.59-1.29)、RR=0.88(95%CI:0.58-1.34)］；5年1级、2级以上放射性皮炎发生率无差异［RR=0.74(95%CI:0.52-1.06)、RR=0.94(95%CI:0.46-1.96)］；5、10年乳房萎缩、乳房硬化及乳房水肿发生率，Meta分析结果分别为RR=0.91(95%CI:0.58-1.43)、RR=0.87(95%CI:0.79-0.96)，RR=0.87(95%CI:0.74-1.02)、RR=0.88 (95%CI:0.78-1.00)，RR=0.64(95%CI:0.51-0.79)、RR=0.65(95%CI:0.52-0.81)，即HOFRT与CRT后5年乳房萎缩及5、10年乳房硬化发生率无统计学差异（P=0.69、P=0.08、P=0.05），10年乳房萎缩及5、10年乳房水肿的发生率有统计学差异（P＜0.0001、P=0.005、P=0.0001）；5年肋骨骨折、肺纤维化及缺血性心脏病的发生率无差异［RR=1.04(95%CI:0.62-1.75)、RR=1.14(95%CI:0.64-2.03)、RR=0.71(95%CI:0.43-1.18)］；5、10年手臂水肿、毛细血管扩张及肩膀僵硬的发生率,Meta分析结果分别为RR=0.67(95%CI:0.36-1.23)、RR=0.67(95%CI:0.26-1.68)、RR=0.61(95%CI:0.41-0.91),RR=0.72(95%CI:0.56-0.95)、RR=0.94(95%CI:0.46-1.91)、RR=0.70(95%CI:0.42-1.15)，即HOFRT与CRT后5、10年手臂水肿、肩膀僵硬的发生率无统计学差异（P=0.19、P=0.39，P=0.86、P=0.16），HOFRT与CRT后5、10年毛细血管扩张的发生率有统计学差异（P=0.01、P=0.02）。结论:与CRT相比，HOFRT组3年生存率较好,10年乳房萎缩及5、10年乳房水肿的发生率及5、10年毛细血管扩张的发生率低，而在3、5、10年无复发生存率、无病生存率、局部复发率、对侧乳腺癌发生率、第二肿瘤的发生率及远处转移率等方面差异无统计学意义。HOFRT是一种可行的治疗方式，明显缩短了疗程，可减轻不良反应发生率，提高了患者的生活质量。由于纳入的研究数量较少且选择入组条件严格,今后尚需要开展高质量的随机对照试验以作进一步的论证。

Hypo fractionated radiation therapy for breast cancer:A Meta analysis

Objective:To assess the long-term effect of breast conservation with hypo fractionated radiation therapy for early-stage breast cancer.Methods:We searched the randomized controlled trial in PubMed,Cochrane Library,EMBASE,SCI,Chinese Biomedical Database,Chinese Studies Online,and Chinese Scientific Journals Full-text Database,China Journal Full-text Database.Quality assessment and data extraction were done by two reviewers independently according to the Cochrane Reviewer's handbook 5.0.0.Meta-analyses were performed on the results of homogenous studies by RevMan5.2.Results:The Meta analysis results showed that:The 3-year of overall survival rate was significant difference［RR=1.03(95%CI:1.01-1.06)］ between the CRT and HOFRT group,The 5,10-year incidence rate of breast edema and telangiectasis were significant difference［RR=0.61(95%CI:0.41-0.91),RR=0.72(95%CI:0.56-0.95)］.The 10-year incidence rate of breast shrinkage was significant difference［RR=0.87(95%CI:0.79-0.96)］.The 5,10-year of overall survival had no significant difference［(RR=1.02(95%CI:0.99-1.06),RR=1.02(95%CI:0.95-1.09)］.No difference of the 5-year excellent to good cosmetic,LR-free survival,disease-free survival,local recurrence,the rate of contra lateral breast cancer and distant metastasis.Conclusion:HOFRT significantly improve the rate of 3-year overall survival results,the 5,10-year incidence rate of breast edema,telangiectasis and the 10-year incidence rate of breast shrinkage were low than CRT.Shortening the course of treatment and alleviate the suffering of patients and improve the quality of life of patients.More RCTs with larger samples and higher quality need to be carried out to make further verification.