Interventions for Radiation-Induced Fibrosis in Patients With Breast Cancer: Systematic Review and Meta-analyses.
Interventions for Radiation-Induced Fibrosis in Patients With Breast Cancer: Systematic Review and Meta-analyses.
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DOI：
10.1016/j.adro.2022.100912
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发表时间：
2022-05
影响因子：
2.3
通讯作者：
Carvalho, Marcos Brasilino de
中科院分区：
文献类型：
--
作者：
Nogueira, Regiane Mazzarioli Pereira;Vital, Flavia Maria Ribeiro;Bernabe, Daniel Galera;Carvalho, Marcos Brasilino de
放射治疗会影响乳腺癌患者的正常组织，引起纤维化等不良反应。虽然有几种治疗放射性纤维化的干预措施，但这些措施的疗效仍不清楚。本综述的目的是评估乳腺癌患者放射性纤维化干预的有效性。这是一个随机临床试验的系统评价。纳入了将任何纤维化干预与另一种干预、安慰剂或无干预进行比较的研究。评估的结局包括纤维化、不良事件、生活质量、治疗依从性、疼痛和功能。共找到2501篇出版物，选择了7项研究，因为它们符合纳入标准。纤维化的干预措施是喷替福林和维生素E，葡萄籽提取物，运动疗法和皮肤疗法。结果显示，乳腺癌患者放射性纤维化的治疗方案及其评价指标存在很大的异质性。荟萃分析显示，与安慰剂或无干预相比，使用戊氨酰茶碱和维生素E没有益处（标准化均值差：−0.30; 95%置信区间，−0.79至0.20; P = .24 [极低证据]）与安慰剂和维生素E相比（标准化平均差异：-0.09; 95%置信区间，-0.66至0.49; P = .77 [中度证据]），分别由晚期效应正常组织工作组-主观、客观、管理和分析（LENT-SOMA）评分量表评估。无法确定这些干预措施治疗乳腺癌患者放射性纤维化的有效性。尽管孤立的研究显示出对实验组有利的显著结果，但由于纳入的一些研究数量少，样本量小，偏倚风险高，因此这些结果应谨慎，这使得对临床实践的建议仍然很弱。
Radiation therapy can affect normal tissues in patients with breast cancer, causing adverse effects such as fibrosis. Although there are several interventions for radiation-induced fibrosis, the efficacy of these procedures is still unclear. The purpose of this review is to evaluate the efficacy of interventions for radiation-induced fibrosis in patients with breast cancer. This is a systematic review of randomized clinical trials. Studies that compared any intervention for fibrosis to another intervention, placebo, or no intervention were included. Outcomes assessed were fibrosis, adverse events, quality of life, treatment adherence, pain, and functionality. A total of 2501 publications were found, and 7 studies were selected because they met the inclusion criteria. The interventions for fibrosis were pentoxifylline and vitamin E, grape seed extract, kinesiotherapy, and endermotherapy. The results showed great heterogeneity in the treatment protocols for radiation-induced fibrosis in patients with breast cancer and in their evaluation metrics. The meta-analyses showed no benefit in using pentoxifylline and vitamin E compared with placebo or no intervention (standardized mean difference: −0.30; 95% confidence interval, −0.79 to 0.20; P = .24 [very low evidence]) compared with placebo and vitamin E (standardized mean difference: −0.09; 95% confidence interval, −0.66 to 0.49; P = .77 [moderate evidence]), respectively, assessed by the Late Effects Normal Tissue Task Force–Subjective, Objective, Management, and Analytic (LENT-SOMA) scoring scale. The effectiveness of these interventions for the treatment of radiation-induced fibrosis in patients with breast cancer could not be determined. Although isolated studies show significant results favorable to the experimental groups, caution should be exercised in these findings because of the small number, small sample size, and high risk of bias presented by some of the included studies, which makes the recommendation for clinical practice still weak.