局限期小细胞肺癌胸部精确放疗的网状Meta分析北大核心CSCD

目的评价精确胸部放射治疗(TRT)局限期小细胞肺癌(LS-SCLC)的有效性及安全性。方法计算机检索PubMed、Web of Science、Cochrane Library、中国知网(CNKI)和万方数据库,搜集LS-SCLC TRT的随机对照试验(RCT),检索时限均从建库至2021年09月01日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 17和R 4.1.1软件进行网状Meta分析。结果共纳入6个RCT,共计1730例患者,涉及6种放疗方案,分别为:超分割放疗(HFRT):45Gy分30次(HFRT_(45))和60Gy分40次(HFRT_(60));常规分割放疗(CFRT):70Gy分35次(CFRT_(70))、66Gy分33次(CFRT_(66));中度大分割放疗(MHFRT):65Gy分26次(MHFRT_(65))和42Gy分15次(MHFRT_(42))。网状Meta分析结果显示,在改善无进展生存期、总生存期方面,6种放疗方案之间比较差异均无统计学意义。概率排序结果分别为MHFRT_(65)>HFRT_(60)>CFRT_(66)>CFRT_(70)>MHFRT_(42)>HFRT_(45)、HFRT_(60)>MHFRT_(65)>CFRT_(66)>CFRT_(70)>HFRT_(45)>MHFRT_(42)。HFRT_(60)方案在降低3级及以上肺炎发生率方面优于其他方案,而各方案导致3级及以上放射性食管炎方面并无差异,概率排序结果分别为HFRT_(60)>MHFRT_(42)>CFRT_(66)>CFRT_(70)>HFRT_(45)>MHFRT_(65)、HFRT_(60)>CFRT_(70)>CFRT_(66)>HFRT_(45)>MHFRT_(42)>MHFRT_(65)。结论HFRT_(60)方案治疗LS-SCLC患者的疗效及安全性可能更优。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

Precision thoracic radiotherapy in limited-stage small cell lung cancer:a network meta-analysis

Objective To systematically evaluate the efficacy and safety of precision thoracic radiotherapy (TRT) in the limited-stage small cell lung cancer (LS-SCLC) patients by network meta-analysis. Methods Randomized controlled trials (RCTs) of TRT regimes in the LS-SCLC were electronically searched from PubMed, Web of Science, The Cochrane Library, CNKI and Wanfang Data from inception to September 1^st, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was performed by Stata 17 and R 4.1.1software. Results A total of 6 RCTs involving 1730 patients with six radiation regimens including hyperfractionated radiotherapy (HFRT):HFRT₄₅(45Gy/30 F) and HFRT₆₀(60Gy/40 F);conventional fractionated radiotherapy (CFRT):CFRT₇₀(70Gy/35 F) and CFRT₆₆(66Gy/33 F);moderately hypofractionated radiotherapy (MHFRT):MHFRT₆₅(65Gy/26 F) and MHFRT₄₂(42Gy/15 F) were included. The network meta-analysis showed that:in terms of improving progression-free survival and overall survival, there was no statistically significant difference among the six radiotherapy regimens. The probabilistic ranking results were:MHFRT₆₅ > HFRT₆₀ > CFRT₆₆ > CFRT₇₀ > MHFRT₄₂ > HFRT₄₅, and HFRT₆₀ > MHFRT₆₅ > CFRT₆₆ > CFRT₇₀ > HFRT₄₅ > MHFRT₄₂, respectively. The HFRT₆₀ regimen was superior to other regimens in reducing the incidence of grade ≥3 pneumonia, and there was no difference between the regimens in causing grade ≥3 radiation esophagitis, and the results of ranking probability were:HFRT₆₀ > MHFRT₄₂ > CFRT₆₆ > CFRT₇₀ > HFRT₄₅ > MHFRT₆₅, and HFRT₆₀ > CFRT₇₀ > CFRT₆₆ > HFRT₄₅ > MHFRT₄₂ > MHFRT₆₅, respectively. Conclusions HFRT₆₀ radiotherapy regimen may be more effective and safer in the treatment of LS-SCLC patients as a priority choice for LS-SCLC TRT. Limited by the number and quality of included studies, the above conclusions need to be verified by more high-quality studies.