不同联合放化疗方式对儿童髓母细胞瘤疗效的系统评价

Therapeutic effect of different combinations of radiotherapy and chemotherapy in treatment of medulloblastoma in children: a systematic review

摘要:

目的 系统评价不同的联合放化疗方式对儿童髓母细胞瘤的疗效。方法 计算机检索MEDLINE/PubMed、Embase和Cochrane Library等数据库,对纳入的随机对照试验(randomized controlled trials, RCT)采用RevMan5.3进行Meta分析。结果 共纳入10篇RCT文献,1807例患者。Meta分析结果显示髓母细胞瘤术后联合放化疗与术后单纯放疗相比,能提高3年总生存率(overall survival, OS)[RR=1.18,95%CI(1.02,1.37),P<0.05]和高危险组患者5年无事件生存率(event-free survival, EFS)或无病生存率(disease-free survival, DFS)[RR=1.27,95%CI(1.01,1.59),P<0.05]。先放疗后持续化疗的方案和先化疗后放疗的"三明治"方案相比,能提高髓母细胞瘤M0级别患者5年OS[RR=1.46,95%CI(1.19,1.79),P<0.05]和5年EFS/DFS[RR=1.29,95%CI(1.06,1.55),P<0.05],能提高M1级别患者5年OS[RR=2.26,95%CI(1.03,4.97),P<0.05]。结论 手术切除后联合放化疗治疗儿童髓母细胞瘤效果优于术后单纯放疗。术后先放疗后化疗的方案优于术后先化疗后放疗的"三明治"方案。

Abstract:

Objective To systematically review the therapeutic effect of different combinations of radiotherapy and chemotherapy in the treatment of medulloblastoma in children.Methods The databases including MEDLINE/PubMed, Embase, and Cochrane Library were searched, and RevMan 5.3 was used for the meta-analysis of the randomized controlled trials (RCTs) included.Results A total of 10 RCTs involving 1807 patients were enrolled. The results of the meta-analysis showed that compared with postoperative radiotherapy alone, postoperative radiochemotherapy improved the 3-year overall survival (OS) (RR=1.18, 95% CI 1.02-1.37; P<0.05) and the 5-year event-free survival (EFS) or disease-free survival (DFS) in the high-risk group (RR=1.27, 95% CI 1.01-1.59; P<0.05). Compared with the regimen of chemotherapy before radiotherapy, the regimen of radiotherapy before continuous chemotherapy improved the 5-year OS (RR=1.46, 95% CI 1.19-1.79; P<0.05) and 5-year EFS/DFS (RR=1.29, 95% CI 1.06-1.55; P<0.05) in patients with M0 medulloblastoma, as well as the 5-year OS (RR=2.26, 95% CI 1.03-4.97; P<0.05) in patients with M1 medulloblastoma.Conclusions Compared with postoperative radiotherapy alone, combined radiochemotherapy after surgical resection has a better therapeutic effect in the treatment of medulloblastoma in children. The regimen of radiotherapy before chemotherapy is better than that of chemotherapy before radiotherapy.