全脑放疗联合靶向治疗与同步放化疗治疗非小细胞肺癌脑转移的疗效及不良反应的Meta分析
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摘要
目的:采用循证医学的方法评价全脑放疗联合靶向治疗与同步放化疗治疗非小细胞肺癌脑转移的疗效及不良反应。方法:电子检索Pubmed、万方、维普、知网数据库,纳入全脑放疗联合靶向治疗与同步放化疗治疗非小细胞肺癌脑转移的文献,检索时间为建库至2018年6月,采用Revman 5.1软件对数据进行Meta分析。结果:共纳入16项研究,共990例患者。结果显示,全脑放疗联合靶向治疗的总体有效率、疾病控制率及1年生存率均高于与同步放化疗组,差异具有统计学意义(P<0.05);联合组的消化道反应及肝脏损伤均小于同步组,差异有统计学意义(P<0.05)。结论:Meta分析表明,全脑放疗联合靶向治疗非小细胞肺癌脑转移的疗效优于同步放化疗组,且不良反应更少。
Objective:Use evidence-based medicine to evaluate the efficacy and side effects of whole brain radiotherapy combined with targeted therapy and concurrent chemoradiotherapy.Methods:Pubmed,Wan Fang,VIP and the Network database were used to search studies of concurrent chemoradiotherapy(CCRT) and whole brain radiotherapy(WBRT)combined with targeted therapy for non-small cell lung cancer with brain metastases.The meta-analysis was performed by the Revman 5.1 software.Results:16 studies containing 990 patients were finally included.The overall efficiency(RR),disease control rate(DCR) and 1-year survival rate of whole brain radiation therapy plus target therapy group were superior to concurrent chemoradiotherapy group(P<0.05).And the gastrointestinal reaction and liver damage of whole brain radiation therapy plus target therapy group were less than concurrent chemoradiotherapy group(P<0.05).Conclusion:The RR,DCR and 1-year survival rate of whole brain radiotherapy combined with targeted therapy on brain metastases of NSCLC is superior to that of concurrent chemoradiotherapy,and with fewer side effects.
Objective:Use evidence-based medicine to evaluate the efficacy and side effects of whole brain radiotherapy combined with targeted therapy and concurrent chemoradiotherapy.Methods:Pubmed,Wan Fang,VIP and the Network database were used to search studies of concurrent chemoradiotherapy(CCRT) and whole brain radiotherapy(WBRT)combined with targeted therapy for non-small cell lung cancer with brain metastases.The meta-analysis was performed by the Revman 5.1 software.Results:16 studies containing 990 patients were finally included.The overall efficiency(RR),disease control rate(DCR) and 1-year survival rate of whole brain radiation therapy plus target therapy group were superior to concurrent chemoradiotherapy group(P<0.05).And the gastrointestinal reaction and liver damage of whole brain radiation therapy plus target therapy group were less than concurrent chemoradiotherapy group(P<0.05).Conclusion:The RR,DCR and 1-year survival rate of whole brain radiotherapy combined with targeted therapy on brain metastases of NSCLC is superior to that of concurrent chemoradiotherapy,and with fewer side effects.
引文
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[11] Dong WW.Effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine,2018,6(1):184-186.[董伟伟.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移疗效分析[J].中西医结合心血管病电子杂志,2018,6(1):184-186.]
[12] Du GW,Peng ZY,Qin C.Clinical efficacy of targeted therapy combined with radiotherapy and chemotherapy in the treatment of brain metastases from lung cancer[J].Chinese Practical Medicine,2016,11(21):32-34.[杜国威,彭宗玉,秦琛.靶向治疗联合放化疗治疗肺癌脑转移患者的临床疗效分析[J].中国实用医药,2016,11(21):32-34.]
[13] Gong X,Chen GQ.Analysis of the effect of brain radiotherapy combined with target therapy and simultaneous radiotherapy and chemotherapy on the control rate and median survival of non small cell lung cancer[J].The Journal of Medical Theory and Practice,2018,31(9):1313-1314.[龚星,陈国庆.脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移对疾病控制率及中位生存期的影响分析[J].医学理论与实践,2018,31(9):1313-1314.]
[14] Li W,Zhang HY,Song TT,et al.The efficacy and safety of targeted therapy combined with concurrent radiotherapy and chemotherapy in patients with brain metastases from lung cancer[J].Chinese Journal of Difficult and Complicated Cases,2015,14 (5):480-482.[李伟,张海燕,宋霆婷,等.肺癌脑转移患者应用靶向治疗联合放化疗同步治疗的疗效及安全性[J].疑难病杂志,2015,14(5):480-482.]
[15] Liu LD,Ye RZ,Wen Q.The effects of erlotinib combined with whole brain radiation clinical treatment on the level of vascular endothelial growth factor C in patients with multiple brain metastases in non small cell lung cancer[J].Chinese Journal of Biochemical Pharmaceutics,2017,37(9):269-270.[刘丽丹,叶瑞智,文强.非小细胞肺癌多发脑转移患者应用厄洛替尼联合全脑放射临床治疗观察及对血管内皮生长因子C水平的影响[J].中国生化药物杂志,2017,37(9):269-270.]
[16] Lu HC.The effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].Medical Information,2015,28(31):214-215.[卢航超.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移疗效分析[J].医学信息,2015,28(31):214-215.]
[17] Pu J,Peng XL.Effect of whole brain radiotherapy combined with erlotinib targeted therapy on brain metastasis of non-small cell lung cancer[J].Contemporary Medicine Forum,2016,14(17):3-5.[蒲军,彭秀兰.使用全脑放疗联合厄洛替尼靶向疗法治疗非小细胞肺癌脑转移的效果观察[J].当代医药论丛,2016,13(17):3-5.]
[18] Wei HM.Comparison of the effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy in patients with brain metastasis from non-small cell lung cancer[J].Contemporary Medicine Forum,2017,15 (16):94-95.[魏慧梅.对非小细胞肺癌脑转移患者进行全脑放疗联合靶向治疗与同步放化疗的效果对比[J].当代医药论丛,2017,15(16):94-95.]
[19] Yue S,Zhang DH,Yuan Y.The clinical effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].Anhui Medical and Pharmaceutical Journal,2017,21(1):123-126.[岳顺,张大红,袁颖.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移的临床疗效[J].安徽医药,2017,21(1):123-126.]
[20] Zhang B,Chen XB.Comparison and analysis of curative effect of radiotherapy (whole brain) combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].J Medical Forum,2017,38(8):117-118.[张斌,陈小兵.放疗(全脑)联合靶向治疗、同步放化疗治疗非小细胞肺癌脑转移疗效对比分析[J].医药论坛杂志,2017,38(8):117-118.]
[21] Zhou D,Xu X,Xie HY,et al.Therapeutic effects of whole brain radiotherapy with targeted therapy and concomitant chemo-radiotherapy in treatment of non·small·cell lung cancer with brain metastasis[J].Journal of Shanghai Jiaotong University(Medical Science),2013,33(4):480-484.[周荻,徐欣,谢华英,等.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移疗效分析[J].上海交通大学学报(医学版),2013,33(4):480-484.]
[22] Sperduto PW,Kased N,Roberge D,et al.Summary report on the graded prognostic assessment:An accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases[J].J Clin Oncol,2012,30(4):419-425.
[23] Kim JH,Kim HS,Kwon JH,et al.Systemic chemotherapy after cranial irradiation in patients with brain metastases from non-small cell lung cancer:a retrospective study[J].Lung Cancer,2009,63(3):405-409.
[24] Robinet G,Thomas P,Breton JL,et al.Results of a phase III study of early versus delayed whole brain radiotherapy with concurrent cisplatin and vinorelbine combination in inoperable brain metastasis of non-small-cell lung cancer:Groupe Francais de Pneumo-Cancérologie (GFPC) Protocol 95-1[J].Ann Oncol,2001,12(1):59-67.
[25] Rosell R,Carcereny E,Gervais R,et al.Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC):A multicentre,open-label,randomised phase 3 trial[J].Lancet Oncol,2012,13(3):239-246.
[26] Wang X,Xu Y,Tang W,et al.Efficacy and safety of radiotherapy plus EGFR-TKIs in NSCLC patients with brain metastases:A meta-analysis of published data[J].Transl Oncol,2018,11(5):1119-1127.
[2] Barnholtz-Sloan JS,Sloan AE,Davis FG,et al.Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System[J].J Clin Oncol,2004,22(14):2865-2872.
[3] Langer CJ,Mehta MP.Current management of brain metastases,with a focus on systemic options[J].J Clin Oncol,2005,23(25):6207-6219.
[4] Counago F,Rodríguez A,Calvo P,et al.Targeted therapy combined with radiotherapy in non-small-cell lung cancer:a review of the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society) [J].Clin Transl Oncol,2017,19(1):31-43.
[5] Mok TS,Wu YL,Thongprasert S,et al.Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma[J].N Engl J Med,2009,361(10):947-957.
[6] Wang F,Ning F,Liu C,et al.Comparison of Gefitinib versus VMP in the combination with radiotherapy for multiple brain metastases from non-small cell lung cancer[J].Cell Biochem Biophys,2015,71(2):1261-1265.
[7] Pesce GA,Klingbiel D,Ribi K,et al.Outcome,quality of life and cognitive function of patients with brain metastases from non-small cell lung cancer treated with whole brain radiotherapy combined with gefitinib or temozolomide.A randomised phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 70/03) [J].Eur J Cancer,2012,48(3):377-384.
[8] Cang HY.Clinical evaluation of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy for brain metastasis of non-small cell lung cancer[J].China Practical Medicine,2018,13(14):109-110.[苍宏宇.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移临床效果评价[J].中国实用医药,2018,13(14):109-110.]
[9] Chen M,Jia L,Han JJ,et al.Study on the efficacy and safety of targeted therapy combined with concurrent radiotherapy and chemotherapy for brain metastases from lung cancer[J].Progress In Modern Biomedicine,2016,16(35):6913-6915.[陈宓,贾霖,韩建军,等.肺癌脑转移患者应用靶向治疗联合放化疗同步治疗的疗效及安全性研究[J].现代生物医学进展,2016,16(35):6913-6915.]
[10] Deng JH,Shi YG.Short-term efficacy of whole brain radiotherapy combined with targeted therapy and concurrent radiochemotherapy for brain metastasis of non-small cell lung cancer[J].Health Care Collection,2015,3(11):117.[邓金慧,石永刚.全脑放疗联合靶向治疗与同步放化疗治疗非小细胞肺癌脑转移的短期疗效分析[J].保健文汇,2015,3(11):117.]
[11] Dong WW.Effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine,2018,6(1):184-186.[董伟伟.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移疗效分析[J].中西医结合心血管病电子杂志,2018,6(1):184-186.]
[12] Du GW,Peng ZY,Qin C.Clinical efficacy of targeted therapy combined with radiotherapy and chemotherapy in the treatment of brain metastases from lung cancer[J].Chinese Practical Medicine,2016,11(21):32-34.[杜国威,彭宗玉,秦琛.靶向治疗联合放化疗治疗肺癌脑转移患者的临床疗效分析[J].中国实用医药,2016,11(21):32-34.]
[13] Gong X,Chen GQ.Analysis of the effect of brain radiotherapy combined with target therapy and simultaneous radiotherapy and chemotherapy on the control rate and median survival of non small cell lung cancer[J].The Journal of Medical Theory and Practice,2018,31(9):1313-1314.[龚星,陈国庆.脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移对疾病控制率及中位生存期的影响分析[J].医学理论与实践,2018,31(9):1313-1314.]
[14] Li W,Zhang HY,Song TT,et al.The efficacy and safety of targeted therapy combined with concurrent radiotherapy and chemotherapy in patients with brain metastases from lung cancer[J].Chinese Journal of Difficult and Complicated Cases,2015,14 (5):480-482.[李伟,张海燕,宋霆婷,等.肺癌脑转移患者应用靶向治疗联合放化疗同步治疗的疗效及安全性[J].疑难病杂志,2015,14(5):480-482.]
[15] Liu LD,Ye RZ,Wen Q.The effects of erlotinib combined with whole brain radiation clinical treatment on the level of vascular endothelial growth factor C in patients with multiple brain metastases in non small cell lung cancer[J].Chinese Journal of Biochemical Pharmaceutics,2017,37(9):269-270.[刘丽丹,叶瑞智,文强.非小细胞肺癌多发脑转移患者应用厄洛替尼联合全脑放射临床治疗观察及对血管内皮生长因子C水平的影响[J].中国生化药物杂志,2017,37(9):269-270.]
[16] Lu HC.The effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].Medical Information,2015,28(31):214-215.[卢航超.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移疗效分析[J].医学信息,2015,28(31):214-215.]
[17] Pu J,Peng XL.Effect of whole brain radiotherapy combined with erlotinib targeted therapy on brain metastasis of non-small cell lung cancer[J].Contemporary Medicine Forum,2016,14(17):3-5.[蒲军,彭秀兰.使用全脑放疗联合厄洛替尼靶向疗法治疗非小细胞肺癌脑转移的效果观察[J].当代医药论丛,2016,13(17):3-5.]
[18] Wei HM.Comparison of the effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy in patients with brain metastasis from non-small cell lung cancer[J].Contemporary Medicine Forum,2017,15 (16):94-95.[魏慧梅.对非小细胞肺癌脑转移患者进行全脑放疗联合靶向治疗与同步放化疗的效果对比[J].当代医药论丛,2017,15(16):94-95.]
[19] Yue S,Zhang DH,Yuan Y.The clinical effect of whole brain radiotherapy combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].Anhui Medical and Pharmaceutical Journal,2017,21(1):123-126.[岳顺,张大红,袁颖.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移的临床疗效[J].安徽医药,2017,21(1):123-126.]
[20] Zhang B,Chen XB.Comparison and analysis of curative effect of radiotherapy (whole brain) combined with targeted therapy and concurrent radiotherapy and chemotherapy on brain metastasis of non-small cell lung cancer[J].J Medical Forum,2017,38(8):117-118.[张斌,陈小兵.放疗(全脑)联合靶向治疗、同步放化疗治疗非小细胞肺癌脑转移疗效对比分析[J].医药论坛杂志,2017,38(8):117-118.]
[21] Zhou D,Xu X,Xie HY,et al.Therapeutic effects of whole brain radiotherapy with targeted therapy and concomitant chemo-radiotherapy in treatment of non·small·cell lung cancer with brain metastasis[J].Journal of Shanghai Jiaotong University(Medical Science),2013,33(4):480-484.[周荻,徐欣,谢华英,等.全脑放疗联合靶向治疗与同步放、化疗治疗非小细胞肺癌脑转移疗效分析[J].上海交通大学学报(医学版),2013,33(4):480-484.]
[22] Sperduto PW,Kased N,Roberge D,et al.Summary report on the graded prognostic assessment:An accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases[J].J Clin Oncol,2012,30(4):419-425.
[23] Kim JH,Kim HS,Kwon JH,et al.Systemic chemotherapy after cranial irradiation in patients with brain metastases from non-small cell lung cancer:a retrospective study[J].Lung Cancer,2009,63(3):405-409.
[24] Robinet G,Thomas P,Breton JL,et al.Results of a phase III study of early versus delayed whole brain radiotherapy with concurrent cisplatin and vinorelbine combination in inoperable brain metastasis of non-small-cell lung cancer:Groupe Francais de Pneumo-Cancérologie (GFPC) Protocol 95-1[J].Ann Oncol,2001,12(1):59-67.
[25] Rosell R,Carcereny E,Gervais R,et al.Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC):A multicentre,open-label,randomised phase 3 trial[J].Lancet Oncol,2012,13(3):239-246.
[26] Wang X,Xu Y,Tang W,et al.Efficacy and safety of radiotherapy plus EGFR-TKIs in NSCLC patients with brain metastases:A meta-analysis of published data[J].Transl Oncol,2018,11(5):1119-1127.