局部晚期非小细胞肺癌诱导化疗后同期放化疗与同期放化疗疗效及安全性Meta分析

目的 不可手术局部晚期非小细胞肺癌经诱导化疗后同期放化疗的获益情况尚缺乏证据.本研究通过对比不可切除局部晚期非小细胞肺癌经诱导化疗后同期放化疗与同期放化疗2种治疗模式下的疗效及安全性,望寻求对局部晚期非小细胞肺癌更有效的治疗方法,为临床治疗手段提供理论依据.方法 计算机检索The Cochrane Library、PubMed、Embase、Web of Science、CBM和CNKI,同时辅佐其他检索途径,搜集2016-06前所有关于局部晚期非小细胞肺癌诱导化疗后同期放化疗与同期放化疗治模式的随机对照试验(randomized controlled clinical study,RCT).质量评价参考2008年Cochrane质量评价标准,统计学分析应用Review Manager 5.2软件.结果 共纳入11个RCT.诱导化疗后同期放化疗与同期放化疗治模式总有效率差异无统计学意义,OR=1.30,95％CI为0.96～1.77,P=0.10;1(OR=1.51,95％CI为0.97～2.43,P=0.07)和2(OR=1.34,95％CI:1.00～1.79,P=0.05)年生存率差异无统计学意义,3年生存率差异有统计学意义,OR=1.43,95％CI:1.02～2.01,P=0.04;Ⅲ～Ⅳ级不良反应中,放射性食管炎(OR=1.96,95％CI:1.06～3.62,P-0.03)和白细胞降低(OR=1.84,95％CI:1.24～2.74,P=0.002)差异有统计学意义,放射性肺炎(OR=1.31,95％CI:0.62～2.77,P=0.48)和恶心呕吐(OR=1.46,95％CI:0.82～2.59,P=0.19)差异无统计学意义.结论 诱导化疗后同期放化疗组Ⅲ～Ⅳ级放射性食管炎、放射性肺炎及白细胞降低发生率较同期放化疗组增多,但无毒性相关死亡,而诱导化疗组3年生存率较同期放化疗组提高,可考虑为临床应用.

Induction chemotherapy plus concomitant chemoradiation versus concomitant chemoradiation in locally advanced non-small cell lung cancer: A Meta-analysis

OBJECTIVE To seek a more effective treatment for locally advanced non small cell lung cancer,and provide theoretical basis for clinical treatment.We performed a meta-analysis of randomized trials directly comparing induction plus concomitant chemoradiation versus concomitant chemoradiation to evaluate the effectiveness and safety of the induction chemotherapy plus concomitant chemoradiation in stage Ⅲ NSCLC patients.METHODS A meta-analysis was performed using trials identified through the Cochrane Library,PubMed,Embase,Web of Science and CBM,CNKI as well as other auxiliary retrieval were searched and all of the RCTs about induction chemotherapy plus concomitant chemoradiation versus concomitant chemoradiation in locally advanced NSCLC were collected.The quality of study was evaluated with Cochrane quality standards,and statistical analysis was performed using Review Manager 5.2 software.RESULTS Of 11 RCTs were analyzed in the study.Meta-analysis results were listed as follows.Short-term effects:the total effective rate (ORR) showed no significant difference (OR =1.30,95 ％ CI:0.96-1.77,P=0.10).Long term effect:the difference of 1 year survival rate and 2 years survival rate was not statistically significant(OR=1.51,95 ％CI:0.97-2.43,P=0.07),(OR=1.34,95％CI:1.00-1.79,P=0.05),but the 3 years survival rate period showed differences (OR=1.43,95 ％ CI:1.02-2.01,P =0.04).Grade Ⅲ-Ⅳ toxicity:esophagitis,leukopenia showed differences (OR=1.96,95％CI:1.06-3.62,P=0.03),(OR=1.84,95％CI:1.24-2.74,P=0.002),pneumonitis and vomiting showed no differences in both arms (OR-1.31,95％CI:0.62-2.77,P=0.48),(OR=1.46,95％CI:0.82-2.59,P=0.19).CONCLUSIONS Induction chemotherapy plus concomitant chemoradiation,as compared with concomitant radiochemo therapy,increased acute esophageal toxicity of the esophagitis and leukopenia,but there was no toxicity related death,and the 3 year survival rate of induction chemotherapy group was increased compared with the concomitant chemoradiation group.This method of induction chemotherapy plus concomitant chemoradiation may be considered for clinic.