A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck.
A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck.
复制标题
在未分离的局部晚期鳞状细胞癌中，对超分配和加速放疗以及联合化疗和放射治疗方案的荟萃分析。
DOI：
10.1186/1471-2407-6-28
复制
发表时间：
2006-01-31
期刊：
影响因子：
3.8
通讯作者：
Dietz, K
中科院分区：
文献类型：
--
作者：
Budach, W;Hehr, T;Budach, V;Belka, C;Dietz, K
先前的荟萃分析显示，在放疗（RT）的基础上增加化疗（CHX），在一定程度上也适用于头颈部局部晚期鳞状细胞癌（SCC）的超分割放疗（HFRT）和加速放疗（AFRT）。然而，新研究的发表，以及纳入这些前荟萃分析的许多旧研究使用过时的辐射剂量、CHX时间表或研究设计，促使我们采用严格的纳入标准进行新的分析。1975年至2003年间发表的以全文或摘要形式发表的针对口腔、口咽部、下咽和喉部SCC的治疗预期放疗（>≥60 Gy, >≥50 Gy, <4周）的随机试验符合条件。对照放疗与同步或交替放化疗（5-氟尿嘧啶（5-FU）、顺铂、卡铂、丝裂霉素C）的试验，根据放疗计划和CHX方案进行分析。比较传统分割放疗（CFRT）与HFRT或无CHX的AFRT的研究分别进行了检查。荟萃分析的终点是总生存期。meta分析纳入了32项试验，共10225例患者。观察到在CFRT或HFRT/AFRT中同时添加CHX的总生存期为12.0个月（p < 0.001）。细胞抑制药物单独分析显示，同时给予5-FU、顺铂、卡铂和丝裂霉素c为基础的CHX至RT的生存期分别延长24.0个月、16.8个月、6.7个月和4.0个月（p < 0.01）。虽然与CFRT相比，AFRT的总生存期没有显著增加，但与CFRT相比，HFRT的中位生存期明显延长（14.2个月，p < 0.001）（均未使用CHX）。RT联合5-FU、顺铂、卡铂和丝裂霉素C作为单一药物或5-FU与其他药物之一联合使用，无论采用何种放疗方案，均可获得较大的生存优势。如果放疗作为单一方式使用，超分割可显著提高总生存率。单独加速放射治疗，特别是分疗程放疗方案或减少总剂量的极加速治疗，并不能提高总生存率。
Former meta-analyses have shown a survival benefit for the addition of chemotherapy (CHX) to radiotherapy (RT) and to some extent also for the use of hyperfractionated radiation therapy (HFRT) and accelerated radiation therapy (AFRT) in locally advanced squamous cell carcinoma (SCC) of the head and neck. However, the publication of new studies and the fact that many older studies that were included in these former meta-analyses used obsolete radiation doses, CHX schedules or study designs prompted us to carry out a new analysis using strict inclusion criteria. Randomised trials testing curatively intended RT (≥60 Gy in >4 weeks/>50 Gy in <4 weeks) on SCC of the oral cavity, oropharynx, hypopharynx, and larynx published as full paper or in abstract form between 1975 and 2003 were eligible. Trials comparing RT alone with concurrent or alternating chemoradiation (5-fluorouracil (5-FU), cisplatin, carboplatin, mitomycin C) were analyzed according to the employed radiation schedule and the used CHX regimen. Studies comparing conventionally fractionated radiotherapy (CFRT) with either HFRT or AFRT without CHX were separately examined. End point of the meta-analysis was overall survival. Thirty-two trials with a total of 10 225 patients were included into the meta-analysis. An overall survival benefit of 12.0 months was observed for the addition of simultaneous CHX to either CFRT or HFRT/AFRT (p < 0.001). Separate analyses by cytostatic drug indicate a prolongation of survival of 24.0 months, 16.8 months, 6.7 months, and 4.0 months, respectively, for the simultaneous administration of 5-FU, cisplatin-based, carboplatin-based, and mitomycin C-based CHX to RT (each p < 0.01). Whereas no significant gain in overall survival was observed for AFRT in comparison to CFRT, a substantial prolongation of median survival (14.2 months, p < 0.001) was seen for HFRT compared to CFRT (both without CHX). RT combined with simultaneous 5-FU, cisplatin, carboplatin, and mitomycin C as single drug or combinations of 5-FU with one of the other drugs results in a large survival advantage irrespective the employed radiation schedule. If radiation therapy is used as single modality, hyperfractionation leads to a significant improvement of overall survival. Accelerated radiation therapy alone, especially when given as split course radiation schedule or extremely accelerated treatments with decreased total dose, does not increase overall survival.
登录
查看更多内容
DOI：
10.1016/0360-3016(94)00475-z
发表时间：
1995-07-15
影响因子：
7
作者：
OKUNIEFF, P;MORGAN, D;SUIT, HD
通讯作者：
SUIT, HD
影响因子：
158.5
作者：
Brizel, DM;Albers, ME;Prosnitz, LR
通讯作者：
Prosnitz, LR
影响因子：
45.3
作者：
FU, KK;PHILLIPS, TL;CARTER, SK
通讯作者：
CARTER, SK
DOI：
10.1016/s0360-3016(02)03792-6
发表时间：
2003-01-01
影响因子：
7
作者：
Olmi, P;Crispino, S;Marsoni, S
通讯作者：
Marsoni, S
DOI：
10.1016/s0360-3016(02)03819-1
发表时间：
2003-01-01
影响因子：
7
作者：
Denis, F;Garaud, P;Calais, G
通讯作者：
Calais, G