Lancet Oncol:MARCH研究更新 诠释放疗分割方案对头颈肿瘤治疗的影响

2017-08-05 佚名 肿瘤资讯

相比第一版的MARCH研究,这项系统分析的更新研究纳入了更多的患者,并且随访的时间更长。研究结果显示,超分割放疗联合同步化疗,是局部进展头颈部鳞癌的标准治疗方案。关于超分割放疗对比同步化疗,还有待更进一步的研究。

相比第一版的MARCH研究,这项系统分析的更新研究纳入了更多的患者,并且随访的时间更长。研究结果显示,超分割放疗联合同步化疗,是局部进展头颈部鳞癌的标准治疗方案。关于超分割放疗对比同步化疗,还有待更进一步的研究。

研究背景

放疗在头颈部鳞癌中的系统分析(Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck,简称MARCH研究)显示,相比传统分割方案,调整分割方案能够改善总生存和疾病无进展生存,其中超分割方案的获益最为明显。这次系统分析的更新,旨在确认和解释超分割方案相比其他方案所具有的优势,以及在同步化疗的背景下评估调整分割方案是否能带来获益。

研究方法

为更新系统分析,作者查阅了文献数据库、临床实验注册数据库以及在2009年1月1日~2015年7月15日,发表及未发表的随机对照实验的会议记录等,进行初始或术后传统分割方案放疗对比调整分割治疗方案放疗(比较1),及传统分割放疗方案联合同步化疗对比单独调整的分割放疗方案(比较2)。如果是随机试验,必须在1970年1月1日及以后开始,并于2010年12月3日结束。随机分配方案也必须排除既往影响治疗分配方案的因素,纳入的病人应为非转移的口腔、口咽、下咽及喉部鳞癌,并接受一线的根治性治疗。对照组中有非常规分割方案,探索大分割放疗方案,以及纳入绝大部分是鼻咽癌的临床实验被排除在外。临床实验根据分割方案的不同,分为三个组:超分割,中度加速分割以及非常加速分割。每一位病人数据的采集和整合都在固定效率模型下进行,并且都基于意向处理分析原则。主要的研究终点是总生存。

结果

比较1(传统分割对比调整分割方案),纳入33项实验,共11423例患者。调整分割放疗方案显示出具有显着意义的总生存的优势(风险比为0.94, 95% CI 0.90~0.98; p=0.0033),5年生存绝对差异为3.1% (95% CI 1.3~4.9) ,10年为 1.2% (95% CI -0.8~3.2)。分割方案和治疗效果之间具有显着的相互作用(p=0.051) ,总生存的获益局限在超分割放疗组(HR 0.83, 0.74~0.92),5年绝对差异为8.1% (3.4~12.8),10年为3.9% (0.6~8.4)。比较2(传统分割放疗方案联合同步化疗对比单独的调整放疗方案)纳入了5项实验,986例患者。调整分割放疗方案的总生存劣于传统分割放疗联合同步化疗(HR 1.22, 1.05~1.42; p=0.0098)。5年生存绝对差异为5.8% (11.9~0.3),10年为5.1% (13.0~2.8)。

原始出处:
Lacas B, Bourhis J, Overgaard J, et al.Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis.Lancet Oncol. 2017 Jul 27. pii: S1470-2045(17)30458-8. doi: 10.1016/S1470-2045(17)30458-8. [Epub ahead of print]

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    2017-11-11 minlingfeng
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    2017-08-08 howi
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    2017-08-07 执迷不悔

    学习了

    0

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    2017-08-06 189****7206

    学习了谢谢分享

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    2017-08-06 luominglian113

    学习了,谢谢分享

    0

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    2017-08-05 有备才能无患

    超分割放疗联合同步化疗,是局部进展头颈部鳞癌的标准治疗方案。关于超分割放疗对比同步化疗,还有待更进一步的研究。

    0

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