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【J Clin Oncol】肺癌姑息性胸部放疗的系统综述
Purpose: The optimal dose of radiotherapy (RT) to palliate symptomatic advanced lung cancer is unclear. We systematically reviewed randomized controlled trials (RCTs) of palliative thoracic RT.
Methods: RCTs comparing two or more dose fractionation schedules were reviewed using the random-effects model of a freely available information management system. The relative risk and 95% CI for each outcome were presented in Forrest plots. Exploratory analysis comparing dose schedules after conversion to the time-adjusted biologically equivalent dose (BED) was performed to investigate for a dose-response relationship.
Results: A total of 13 RCTs involving 3,473 randomly assigned patients were identified. Outcomes included symptom palliation, overall survival, toxicity, and reirradiation rate. For symptom control in assessable patients, lower-dose (LD) RT was comparable with higher-dose (HD), except for the total symptom score (TSS): 65.4% of LD and 77.1% of HD patients had improved TSS (P = .003). Greater likelihood of symptom improvement was seen with schedules of 35 Gy10 versus lower BED. At 1 year after HD and LD RT, 26.5% versus 21.7% of patients were alive, respectively (P = .002). Sensitivity analysis suggests this survival improvement was seen with 35 Gy10 BED schedules compared with LDs. Physician-assessed dysphagia was significantly greater in the HD arm (20.5% v 14.9%; P = .01), and the likelihood of reirradiation was 1.2-fold higher after LD RT.
Conclusion: No significant differences were observed for specific symptom-control end points, although improvement in survival favored HD RT. Consideration of palliative thoracic RT of at least 35 Gy10 BED may therefore be warranted, but must be weighed against increased toxicity and greater time investment.
http://jco.ascopubs.org/cgi/content/abstract/26/24/4001 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Palliative Thoracic Radiotherapy for Lung Cancer: A Systematic Review
肺癌的姑息放疗：系统文献回顾。
Purpose: The optimal dose of radiotherapy (RT) to palliate symptomatic advanced lung cancer is unclear. We systematically reviewed randomized controlled trials (RCTs) of palliative thoracic RT.
目的：进展期肺癌的姑息性放疗最佳剂量尚不清楚。我们系统性回顾了肺癌姑息性放疗的随机对照研究（RCTs）。
Methods: RCTs comparing two or more dose fractionation schedules were reviewed using the random-effects model of a freely available information management system. The relative risk and 95% CI for each outcome were presented in Forrest plots. Exploratory analysis comparing dose schedules after conversion to the time-adjusted biologically equivalent dose (BED) was performed to investigate for a dose-response relationship.
方法：RCTs对比了两种或更多种剂量分割法，使用了基于免费信息管理系统的随机效果模型。每项结果的相关风险和95％CI使用Forrest plots来表示。为评估剂量反应相关性而转换时间调整的生物等效剂量，探索性分析对比了不同剂量计划，
Results: A total of 13 RCTs involving 3,473 randomly assigned patients were identified. Outcomes included symptom palliation, overall survival, toxicity, and reirradiation rate. 结果：总共纳入了13个RCTs，包括3473名随机入组的患者。结果包括症状缓解、总生存率、毒性和再放疗率。For symptom control in assessable patients, lower-dose (LD) RT was comparable with higher-dose (HD), except for the total symptom score (TSS): 65.4% of LD and 77.1% of HD patients had improved TSS (P = .003). 在可评估患者的症状控制上，除外总体症状分数（TSS），对比了低剂量和高剂量放疗：接受低剂量的65.4％和高剂量的77.1％患者提高了TSS(P = .003)。Greater likelihood of symptom improvement was seen with schedules of 35 Gy10 versus lower BED. At 1 year after HD and LD RT, 26.5% versus 21.7% of patients were alive, respectively (P = .002). 相对了低生物学剂量，35 Gy/10f方案更好地缓解了症状。分别接受低剂量和高剂量放疗的患者，一年生存率为26.5% 和 21.7%(P = .002)。Sensitivity analysis suggests this survival improvement was seen with 35 Gy10 BED schedules compared with LDs. Physician-assessed dysphagia was significantly greater in the HD arm (20.5% v 14.9%; P = .01), and the likelihood of reirradiation was 1.2-fold higher after LD RT. 敏感性分析提示，相对于低剂量放疗，该生存优势在35 Gy/10f BED计划中体现。临床上可评估的吞咽困难在高剂量组更明显(20.5% v 14.9%; P = .01)，在低剂量放疗后行再放疗的几率为1.2倍。
Conclusion: No significant differences were observed for specific symptom-control end points, although improvement in survival favored HD RT. Consideration of palliative thoracic RT of at least 35 Gy10 BED may therefore be warranted, but must be weighed against increased toxicity and greater time investment.
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作者:admin@医学,生命科学 2011-02-06 05:14
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