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调强放疗越来越多地被应用在头颈癌的治疗中,但目前,其与传统2D-RT,3D-CRT的疗效比较仍未明确。本研究旨在对比调强放疗和传统放疗在头颈癌的疗效。通过检索Pubmed、Cochrane图书馆、Medline数据库、Embase数据库等数据库,收集有关对比IMRT和2D-RT或3D-RT的随机对照研究。并由2名研究人员按照纳入排除标准独立提取文献中的相关数据,2~4级口腔干燥发生率,肿瘤局部控制率及总生存率作为研究的测量指标。采用Rev Man 5.3软件进行Meta分析并作图。经过纳入排除筛选后,一共纳入关于IMRT和2D-RT或3D-CRT对比的前瞻性随机对照研究5篇。一共纳入871名患者,其中2D-RT或3D-CRT组共437名患者,IMRT组共434名患者。82%的患者为鼻咽癌,62.1%的患者为三或四期。经分析发现相比其他组患者,IMRT组患者2~4级口腔干燥的发生率明显降低(HR=0.76;95%CI:0.66,0.87;p<0.000 1),提高患者术后总生存率(OR=1.70,95%CI 1.23~2.35,p=0.001)。而对肿瘤局部控制率(OR=1.92,95%CI 0.85~1.97,p=0.23)则没有显著性影响。本研究证明IMRT能够显著性降低患头颈癌患者2~4口腔干燥的发生率以及提高生存率,而不会影响肿瘤局部控制率。
Intensity modulated radiation therapy is increasingly used in the treatment of head and neck cancer, but at present, its efficacy compared with traditional 2D-RT and 3D-CRT remains unclear. The aim of this study was to compare the efficacy of IMRT and conventional radiotherapy in head and neck cancer. Randomized controlled studies comparing IMRT with 2D-RT or 3D-RT were collected by searching databases such as Pubmed, The Cochrane Library, Medline database, Embase database. Two researchers independently extracted the relevant data in the exclusion criteria, and the incidence rates of grade 2-4 oral dryness, tumor local control and overall survival were taken as the measurement indexes. RevMan 5.3 software for meta-analysis and mapping. A total of 5 prospective randomized controlled trials comparing IMRT to 2D-RT or 3D-CRT were included after inclusion and exclusion. A total of 871 patients were enrolled, 437 patients in the 2D-RT or 3D-CRT group and 434 in the IMRT group. 82% of patients are nasopharyngeal cancer, 62.1% of patients are three or four. The analysis found that patients in the IMRT group had significantly lower rates of grade 2 to 4 oral drowning (HR = 0.76; 95% CI: 0.66, 0.87; p <0.000 1) and improved overall postoperative survival ( OR = 1.70, 95% CI 1.23-2.35, p = 0.001). There was no significant effect on tumor local control (OR = 1.92, 95% CI 0.85-1.97, p = 0.23). This study demonstrates that IMRT can significantly reduce the incidence of oral 2-4 mouth and neck cancer patients with increased survival and without affecting the local control rate of tumor.