中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (2): 325-330.doi: 10.3969/j.issn.1673-8225.2012.02.031

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

质子治疗非小细胞肺癌的系统评价**

王晓晶1, 2，田金徽1，姜  金1, 2   

  1. 1兰州大学基础医学院循证医学中心，甘肃省兰州市 730000；2兰州大学第二临床医学院，甘肃省兰州市730000
  • 收稿日期:2011-04-23 修回日期:2011-05-07 出版日期:2012-01-08 发布日期:2012-01-08
  • 通讯作者: 田金徽，硕士，讲师，兰州大学基础医学院循证医学中心，甘肃省兰州市 730000tjh996@163.com
  • 作者简介:王晓晶，女，1990年生，汉族，甘肃省天水市人，兰州大学本科在读，主要从事循证放射治疗的研究。wang.xiaojing1990@163.com
  • 基金资助:

    重离子等射线治疗肿瘤研究科技创新团队建设计划(098TTCA009); 兰州大学循证医学中心循证医学创新项目(2011LDEBM-B)。

R318A systematic review of proton therapy for non-small cell lung cancer 

Wang Xiao-jing1, 2, Tian Jin-hui1, Jiang Jin1, 2   

  1. 1Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou  730000, Gansu Province, China; 2Second Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China
  • Received:2011-04-23 Revised:2011-05-07 Online:2012-01-08 Published:2012-01-08
  • Contact: Tian Jin-hui, Master, Lecturer, Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China tjh996@163.com
  • About author:Wang Xiao-jing, Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China; Second Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, China wang.xiaojing1990@163.com
  • Supported by:

    Science and Technology Innovation Team Construction Plan Regarding Heavy Ion Beam Irradiation for Treatment of Tumor, No. 098TTCA009*; Evidence Based Medical Innovation Program of Evidence Based Center of Lanzhou University, No. 2011LDEBM-B* 
       

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摘要：

背景：质子治疗能量大，侧向辐射小，其射束的深度剂量分布曲线在其末端形成博拉格峰，提高了肿瘤的局部控制率，减小了周围正常组织器官并发症的发生率。
目的：评价质子治疗非小细胞肺癌的临床疗效和安全性。
方法：检索PubMed、Cochrane library、EMBASE、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库，收集质子治疗非小细胞肺癌的临床研究，提取数据，并采用方法学评价指标对纳入研究进行质量评价，对满足条件的数据采用RevMan5.0进行合并分析，对不能合并的进行描述。
结果与结论：共纳入11个临床研究，308例患者，主要为Ⅰ期临床试验。非小细胞肺癌的质子治疗2~5年局部控制率为57%~87%，2年和5年总生存率分别为62%~84%和29%，晚期毒性的发生率为10%。与光子治疗相比，质子治疗在正常肺组织及邻近重要器官的照射剂量方面的差异有显著性意义。说明质子治疗非小细胞肺癌很有临床应用的前景。但在质子治疗作为一种国际标准化的治疗方法应用于非小细胞肺癌患者前，尚需在各期患者中进行高质量大样本的临床研究。

关键词: 质子, 非小细胞肺癌, 系统评价, 临床疗效, 安全性

Abstract:

BACKGROUND: The morbidity and mortality of non-small cell lung cancer (NSCLC) rank first in all countries worldwide, and radiotherapy is the main treatment for medically inoperable patients. This effect of proton energy deposition toward the end of the beam path is known as the Bragg peak. Accordingly, proton therapy should help improve the local control rate and minimize the incidence and severity of pulmonary, heart, and esophageal injury. However, the present role of proton therapy in the treatment lung cancer is still unclear.
OBJECTIVE: To assess the efficacy of the proton therapy for the NSCLC.
METHODS: We searched the electronic bibliographic databases, including Cochrane library, PubMed, EMBASE, China Journal Full-text Database, Chinese Biomedical Database, and Chinese Scientific Journals Full-text Database to assemble the clinical trials of the proton treatment for the NSCLC. Using the MINORS to evaluate the quality of studies, all the related date that matched our standards were abstracted for Meta analysis by RevMan 5.0.
RESULTS AND CONCLUSION: Eleven clinical trials including 308 patients, mainly stageⅠ were identified. No phase Ⅲ trials were found. 2-5 year local tumor control rates varied between 87% and 57%. The 2-year and 5-year overall survival varied 62%-84% and 29%. Late side effects were observed in about 10% of the patients. Compared with the photon therapy, proton treatment significantly reduced dose to the normal lung, esophagus, and spinal cord. Although current results with proton therapy for NSCLC are promising, more evidence is required before proton therapy can become internationally the standard treatment for lung cancer patients.

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