中国循证医学杂志

中国循证医学杂志

中晚期子宫内膜癌术后放疗效果的系统评价

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目的 系统评价术后放疗在中晚期子宫内膜癌的治疗效果、安全性及成本效果。
方法 电子检索Cochrane图书馆、The Cochrane Central Register of Controlled Trials(CENTRAL)、The National Research Register、Health technology assessment database(HTA)、MEDLINE、 EMbase、CancerLit、CBMdisc、VIP、万方学位论文数据库、CNKI并辅以手工检索。检索时间截至2007年3月,收集子宫内膜癌(EC)术后放疗与术后非放疗比较的随机对照试验(RCT)。由两名研究者按Cochrane系统评价方法,独立选择试验,提取资料、评价纳入研究的方法学质量,提取有效数据进行Meta分析。
结果 共纳入符合标准的RCT 3个,患者1126例, 3个RCT均是术后盆腔放疗与术后化疗的比较,其中2个RCT为放疗与CAP化疗方案比较,包括730例患者;1个RCT为放疗与AP化疗方案比较,包括396例患者。Meta分析结果显示:对子宫内膜癌Ic、II、III期患者,其5、7年总体生存率、疾病无进展存活率及5年局部复发率、远处复发率、总复发率,在放疗组与化疗组的差异无统计学意义;对子宫内膜癌III、IV期患者,其5年总体生存率、疾病无进展存活率,化疗组优于放疗组;在3/4级消化系统及泌尿生殖系毒性反应方面,化疗组与放疗组的差异无统计学意义;而3/4级血液学毒性反应方面,化疗组高于放疗组。
结论 对子宫内膜癌Ic、II、III期患者,术后盆腔放疗的效果和化疗相似;但对子宫内膜癌III、IV期患者,放疗的效果比化疗差;放疗的骨髓抑制作用比化疗小,在胃肠道和泌尿生殖系3/4级毒性反应,两者差异无统计学意义。

Objective To evaluate the clinical effectiveness, safety and cost-effectiveness of postoperative radiotherapy on endometrial carcinoma.
Methods We searched The Cochrane Library, The Cochrane Central Register of Controlled Trials (CENTRAL), The National Research Register, Health Technology Assessment Database (HTA), MEDLINE, EMbase, CancerLit, CBMdisc, VIP, WANFANG DATABASE and CNKI to March 2007. Relevant journals were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed.
Results Three RCTs involving 1126 patients were included. Each of the 3 RCTs compared adjuvant radiotherapy (external beam radiotherapy, EBRT) versus chemotherapy. Two trials (730 patients) compared adjuvant radiotherapy versus CAP chemotherapy (carboplatin + adriamycin + cisplatin). The other trial (396 patients) compared adjuvant radiotherapy versus AP chemotherapy (adriamycin + cisplatin). The meta-analyses showed that for patients with endometrial cancer at stage Ic, II or III, there were no significant differences between adjuvant radiotherapy and CAP in 5-year overall survival (OS), 5-year progress-free survival (PFS) and 5-year recurrence (local, distant, total). For patients with endometrial cancer at stage III or IV, adjuvant radiotherapy was superior to AP regimen on 5-year OS and 5-year PFS. The incidence of grade 3/4 toxicities of digestive system and urogenital system was similar between the two groups of patients. The chemotherapy group showed a higher incidence of grade 3/4 toxicities of hematology than the radiotherapy group.
Conclusion The effect of adjuvant pelvic radiotherapy for endometrial carcinoma at stage Ic, II or III is similar to that of adjuvant chemotherapy. However, for endometrial carcinoma at stage III or IV, the effect of radiotherapy is superior to that of chemotherapy. Radiotherapy has a lower role of myelosuppression than chemotherapy. No significant difference was observed between the radiotherapy and chemotherapy in grade 3/4 toxicities of the digestive system and the urogenital system.

关键词: 辅助性放疗; 子宫内膜癌; 系统评价; 随机对照试验; Meta分析

Key words: Adjuvant radiotherapy; Endometrial carcinoma; Systematic review; Randomized controlled trial; Meta-analysis

引用本文: 魏冬梅,梅玲,方芳,吴泰相,刘关键. 中晚期子宫内膜癌术后放疗效果的系统评价. 中国循证医学杂志, 2008, 08(4): 244-251. doi: 10.7507/1672-2531.20080054 复制

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