质子治疗非小细胞肺癌的系统评价

背景：质子治疗能量大,侧向辐射小,其射束的深度剂量分布曲线在其末端形成博拉格峰,提高了肿瘤的局部控制率,减小了周围正常组织器官并发症的发生率。目的：评价质子治疗非小细胞肺癌的临床疗效和安全性。方法：检索PubMed、Cochrane library、EMBASE、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库,收集质子治疗非小细胞肺癌的临床研究,提取数据,并采用方法学评价指标对纳入研究进行质量评价,对满足条件的数据采用RevMan5.0进行合并分析,对不能合并的进行描述。结果与结论：共纳入11个临床研究,308例患者,主要为Ⅰ期临床试验。非小细胞肺癌的质子治疗2~5年局部控制率为57%~87%,2年和5年总生存率分别为62%~84%和29%,晚期毒性的发生率为10%。与光子治疗相比,质子治疗在正常肺组织及邻近重要器官的照射剂量方面的差异有显著性意义。说明质子治疗非小细胞肺癌很有临床应用的前景。但在质子治疗作为一种国际标准化的治疗方法应用于非小细胞肺癌患者前,尚需在各期患者中进行高质量大样本的临床研究。

A systematic review of proton therapy for non-small cell lung cancer

BACKGROUND： The morbidity and mortality of non-small cell lung cancer （NSCLC） rank first in all countries worldwide, and radiotherapy is the main treatment for medically inoperable patients. This effect of proton energy deposition toward the end of the beam path is known as the Bragg peak. Accordingly, proton therapy should help improve the local control rate and minimize the incidence and severity of pulmonary, heart, and esophageal injury. However, the present role of proton therapy in the treatment lung cancer is still unclear. OBJECTIVE： To assess the efficacy of the proton therapy for the NSCLC. METHODS： We searched the electronic bibliographic databases, including Cochrane library, PubMed, EMBASE, China Journal Full-text Database, Chinese Biomedical Database, and Chinese Scientific Journals Full-text Database to assemble the clinical trials of the proton treatment for the NSCLC. Using the MINORS to evaluate the quality of studies, all the related date that matched our standards were abstracted for Meta analysis by RevMan 5.0. RESULTS AND CONCLUSION： Eleven clinical trials including 308 patients, mainly stageⅠ were identified. No phase Ⅲ trials were found. 2-5 year local tumor control rates varied between 87% and 57%. The 2-year and 5-year overall survival varied 62%-84% and 29%. Late side effects were observed in about 10% of the patients. Compared with the photon therapy, proton treatment significantly reduced dose to the normal lung, esophagus, and spinal cord. Although current results with proton therapy for NSCLC are promising, more evidence is required before proton therapy can become internationally the standard treatment for lung cancer patients.