| 诱导化疗联合同步放化疗对局部晚期头颈鳞状细胞癌疗效和安全性的Meta分析 |
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| 引用本文： | 白静,宋琦,黄则雷,李晓明,崔兰珍. 诱导化疗联合同步放化疗对局部晚期头颈鳞状细胞癌疗效和安全性的Meta分析[J]. 中国耳鼻咽喉头颈外科, 2017, 24(11): 575-581. DOI: 10.16066/j.1672-7002.2017.11.006 |
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| 作者姓名： | 白静 宋琦 黄则雷 李晓明 崔兰珍 |
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| 摘 要： | 目的 通过Meta分析客观评价诱导化疗联合同步放化疗与单纯同步放化疗治疗局部晚期头颈鳞状细胞癌的疗效和安全性，为临床治疗提供指导。方法 计算机检索PubMed、Embase、Cochrane Library和中国生物医学文献数据库（CBM）等数据库中的随机对照临床试验。检索时限从建库至2017年2月，选择治疗组为诱导化疗联合同步放化疗，对照组为单纯同步放化疗。主要提取指标为总生存期（OS）、无进展生存期（PFS）、总体反应率（ORR）等，次要提取指标为3～4级不良反应，如白细胞减少、中性粒细胞减少、血小板减少、口腔黏膜炎、皮肤反应、恶心及呕吐和吞咽困难等。结果使用Cochrane 协作组提供的RevMan5.3 软件和Stata12.0软件进行统计分析。结果 共纳入6篇随机对照研究，其中英文5篇，中文1篇，共计1141例患者，诱导化疗联合同步放化疗组659例，同步放化疗组482例。Meta分析结果显示：两组患者的肿瘤完全缓解（CR）、部分缓解（PR）、稳定进展（SD）、疾病进展（PD）、ORR及OS、PFS均无显著统计学差异（P＞0.05）。对于3～4级不良反应，诱导化疗联合同步放化疗组较同步放化疗组有较明显的发热性中性粒细胞减少症及口腔炎/口腔黏膜炎发生率（OR=6.99，95%CI ：2.43~20.12；OR=1.92，95%CI ：1.43~2.58），其他不良反应事件的发生率两组未见显著统计学差异。结论 目前对于局部晚期头颈鳞癌患者，诱导化疗联合同步放化疗较单纯同步放化疗，并不能有效提高患者总体反应率，不能有效延长总体生存时间及无进展生存时间；并且其发热性中性粒细胞减少症及口腔炎/口腔黏膜炎发生率增加，其他不良反应事件的发生率两组未见显著统计学差异。
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| 关 键 词： | 头颈部肿瘤 治疗结果 Meta分析[文献类型] 诱导化疗 |
Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone for treatment of locally advanced head and neck squamous cell carcinoma: A meta-analysis of randomized trials |
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| Abstract: | OBJECTIVE To systematically review the efficacy and safety of induction chemotherapy before concurrent chemoradiotherapy.METHODS We comprehensively searched the CBM,Pubmed,Embase,and the Cochrane databases to identify published studies.Quality assessment of RCTs was conducted according to the methods of Cochrane collaboration.A meta-analysis was performed by using the Revman 5.3 software and Stata12.0software.Primary outcomes included overall survival (OS),progression-free survival (PFS) and overall response rate (ORR).Serious adverse events include neutropenia,anemia,skin reactions,vomiting,etc.RESULTS A Total 6 randomized controlled trials involving 1141 patients were included.There was no significant difference in 1-year survival rate,2-year survival rate,3-year survival rate,5-year survival rate between the two groups(P＞0.05).The 1-year PFS,2-year PFS,3-year PFS,5-year PFS,ORR also showed no difference between the 2 cohorts(P＞0.05).However,the incidence of grade 3 to 4 febrile neutropenia and oral mucositis was higher in the group of induction chemotherapy followed by concurrent chemoradiotherapy (OR=6.99,95％CI:2.43～20.12;OR=1.92,95％CI:1.43～2.58).CONCLUSION Additional induction chemotherapy before concurrent chemoradiotherapy does not improve OS and PFS in locally advanced HNSCC compared to concurrent chemoradiotherapy alone,and can cause a higher incidence of adverse events. |
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