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背景与目的:~(125)I粒子植入被用于治疗多种肿瘤,但在胶质瘤中的疗效尚不肯定。本文系统评价手术联合~(125)I粒子植入放射治疗与单纯手术治疗复发性胶质瘤患者的有效性。方法:计算机检索PubMed、EMbase、Cochrane Library、CNKI、CBM、VIP和万方数据库,收集所有相关的临床研究的随机对照试验(RCT)。由2位研究人员独立进行资料提取和质量评估后.采用RevMan5.2软件进行meta分析,采用GRADE系统对证据质量进行评估分级。结果:纳入3个研究,合计患者148例。Meta分析结果显示:与单纯手术治疗相比,~(125)I粒子植入放射治疗可以提高复发性脑胶质瘤患者术后12个月总生存率(RR=2.09,95%CI:1.33~3.28,P=0.001)。资料中生存时间为中位生存时间,相关数据不全,未能行合并分析。所有研究均提示手术联合~(125)I粒子植入放射治疗组的疗效优于单纯手术组。GRADE系统评价分级结果显示,证据水平均不高于C级。结论:手术联合~(125)I粒子植入放射治疗对于治疗复发性脑胶质瘤是一种有效的辅助治疗手段。基于GRADE系统的证据质量偏低,尚需要更多大样本高质量的RCT以进一步论证。
BACKGROUND & AIM: ~ (125) I particle implantation is used to treat a variety of tumors, but its efficacy in gliomas remains uncertain. This article systematically evaluated the effectiveness of surgery combined with 125 I seed implantation radiotherapy and surgery alone in patients with recurrent glioma. METHODS: We searched PubMed, EMbase, Cochrane Library, CNKI, CBM, VIP and Wanfang database for randomized controlled trials (RCTs) of all relevant clinical trials. Two researchers independently conducted data extraction and quality evaluation, then used RevMan5.2 software to conduct meta-analysis and GRADE system to evaluate and grade the quality of evidence. Results: Three studies were included, totaling 148 patients. The results of Meta analysis showed that ~ (125) I particle implantation radiotherapy can improve the overall survival at 12 months after recurrent glioma (RR = 2.09, 95% CI: 1.33 ~ 3.28, P = 0.001). Data survival time for the median survival time, the relevant data is incomplete, failed to line merge analysis. All the studies suggest that the combined operation of 125 I seeds implantation and radiotherapy group is better than the simple operation group. The grading results of the GRADE Systematic Review showed that the level of evidence was no higher than Grade C. Conclusion: The combination of surgery and 125 I seed implantation radiotherapy is an effective adjuvant therapy for recurrent glioma. The low quality of evidence based on the GRADE system still requires more samples of high quality RCTs for further demonstration.