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目的系统评价热疗联合放化疗治疗中晚期宫颈癌的疗效和安全性。方法计算机检索Pub Med、The Cochrane Library(2013年第6期)、CNKI、Wan Fang Data和VIP数据库,纳入所有关于热疗辅助放疗和/或化疗治疗中晚期宫颈癌的随机对照试验(RCT),检索时限均为从建库至2013年7月1日。由2位研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2.6软件进行Meta分析。结果共纳入6个RCT。由于各研究结果间存在明显的异质性,故仅进行描述性分析。纳入的6个RCT中,4个RCT结果显示热疗可提高完全缓解率;3个RCT报告了客观有效率,但仅1个RCT显示热疗可显著提高客观有效率。所有试验均报告了总生存情况,但仅1个RCT显示热疗可显著改善总生存情况。仅1个RCT报告了3年无进展生存率,其结果显示热疗可以改善3年无进展生存率。2个RCT报告了无疾病生存率,其中仅1个RCT显示热疗联合放化疗可提高1年无疾病生存率。2个RCT报告了毒副反应发生情况,其中1个RCT显示热疗会明显增加2~3级急性毒副反应的发生,但远期反应不清楚。结论当前证据尚不足以证实热疗辅助治疗宫颈癌的疗效和安全性,仍需进一步开展大样本、设计良好的RCT来研究热疗在宫颈癌综合治疗中的作用。
Objective To evaluate the efficacy and safety of thermotherapy combined with chemoradiotherapy in the treatment of advanced cervical cancer. Methods We searched Pub Med, The Cochrane Library (2013), CNKI, Wan Fang Data and VIP database for all randomized controlled trials (RCTs) on hyperthermia adjuvant radiotherapy and / or chemotherapy for advanced cervical cancer. The search time is from the database to July 1, 2013. After two investigators screened the literature for inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies, Meta-analysis was performed using Rev Man 5.2.6 software. Results A total of 6 RCTs were included. Due to the significant heterogeneity among the studies, only descriptive analyzes were performed. Of the 6 RCTs included, 4 of the RCTs showed hyperthermia to improve the complete remission rate; 3 of the RCTs reported objectively effective, but only 1 RCT showed that hyperthermia significantly increased objective efficiency. Overall survival was reported in all trials, but only 1 RCT showed that hyperthermia significantly improved overall survival. Only one RCT reported a 3-year progression-free survival rate and the results showed that hyperthermia improved 3-year progression-free survival. Two RCTs reported disease-free survival, of which only 1 RCT showed hyperthermia in combination with chemoradiation increased 1-year disease-free survival. Two RCTs reported the occurrence of toxic side effects. One of the RCTs showed that hyperthermia significantly increased grade 2 to 3 acute toxicities but the long-term response was unclear. Conclusion The current evidence is not yet sufficient to confirm the efficacy and safety of hyperthermia adjuvant treatment of cervical cancer, still need to carry out a large sample of well-designed RCT to study the role of hyperthermia in the comprehensive treatment of cervical cancer.