【作者】 谭兆华；

【导师】 申良方；

【作者基本信息】 中南大学 ， 临床医学， 2013， 博士

【摘要】 目的：通过系统评价的方法,比较间变性胶质瘤术后放化疗联合治疗和单独放疗的疗效,从而探讨放化疗联合治疗在间变性胶质瘤术后应用的可行性。方法：制定纳入和剔除标准。制定检索词,计算机检索PubMed、 EMBASE和the Coehrane Libraty三大外文数据库,以及中国生物医学文献数据库、中国学术期刊网络出版总库、中文科技期刊数据库(维普)、万方数据期刊论文资源等中文数据库,并通过手工检索相关医学杂志和互联网。文献检索语种限定为中文和英文,时间限定为1998年1月至2013年3月。根据纳入标准对文献的设计类型、研究对象、干预措施及结局指标进行评价,筛选放化疗联合治疗与单独放疗的随机对照试验的相关文献。纳入的文献采用Cochrane Reviewer Handbook5.1.0中偏倚风险评价工具的六条质量评价标准进行评价,分为A、B、C三个等级。用总生存时间(Overall survival,OS)和无进展生存期(Progress Free Survival, PFS)指标来评价干预措施的有效性。采用stata软件进行Meta分析,采用危险比(hazard ratio, HR)为合并效应量的统计指标。结果：1.检索结果：共4项试验研究,包括965例患者符合纳入标准纳入本研究,其中放化疗联合治疗组480例,单独放疗组485例。按昭Cochrane协作网的偏倚风险评价工具进行质量评价,4个研究均为B级。2.统计分析结果(1)间变性胶质瘤患者,放化疗联合治疗组与单独放疗组相比：①放化疗联合治疗可以延长间变性胶质瘤的OS[HR=0.74(95%CI,0.64-0.82)]；②放化疗联合治疗对间变性星形细胞瘤的OS无影响[HR=0.79(95%CI,0.61-1.02)]；③放化疗联合治疗可以延长间变性少突胶质细胞瘤/间变性少突-星形细胞瘤的OS[HR=0.72(95%CI,0.600.86)]；(2)间变性胶质瘤患者,放化疗联合治疗组与单独放疗组相比：放化疗联合治疗可以延长间变性胶质瘤的PFS[HR=0.67(95%CI,0.560.79)]；(3)间变性少突胶质细胞瘤/间变性少突-星形细胞瘤患者中,伴有染色体1p19q杂合性缺失组与单个基因缺失或无基因缺失组相比：伴有染色体1p19q杂合性缺失组的5年OS和5年PFS均较高[HR=0.41(95%CI,0.23—0.72)和HR=0.43(95%CI,0.38—0.49)];(4)间变性少突胶质细胞瘤/间变性少突-星形细胞瘤伴有染色体1p19q杂合性缺失患者中,放化疗联合治疗组与单独放疗组相比：①放化疗联合治疗可以延长5年OS[HR=0.58(95%CI,0.40-0.84)]；②放化疗联合治疗可以延长5年PFS■HR=0.45(95%CI,0.32—0.64)]。结论：1.术后间变性胶质瘤患者,放化疗联合治疗能够延长患者的OS和PFS,其中放化疗联合治疗对各个病理亚组的影响有待进一步研究。2.间变性少突胶质细胞瘤/间变性少突-星形细胞瘤患者中,伴有染色体lp19q杂合性缺失组较单个基因缺失或无基因缺失组相比,预后好,5年OS和5年PFS均有延长。3.间变性少突胶质细胞瘤/间变性少突-星形细胞瘤伴有染色体lp19q杂合性缺失患者中,放化疗联合治疗能够延长患者的OS和PFS。目的：通过系统评价的方法,比较低级别胶质瘤术后高剂量放疗与低剂量放疗的疗效。方法：制定纳入和剔除标准。制定检索词,计算机检索PubMed、 EMBASE和the Coehrane Libraty三大外文数据库,以及中国生物医学文献数据库、中国学术期刊网络出版总库、中文科技期刊数据库(维普)、万方数据期刊论文资源等中文数据库,并通过手工检索相关医学杂志和互联网。文献检索语种限定为中文和英文,时间限定为建库以来至2013年3月。根据纳入标准对文献的设计类型、研究对象、干预措施及结局指标进行评价,筛选放化疗联合治疗与单独放疗的随机对照试验的相关文献。纳入的文献采用Cochrane Reviewer Handbook5.1.0中偏倚风险评价工具的六条质量评价标准进行评价,分为A、B、C三个等级。用总生存率(Overall survival,OS)和无进展生存率(Progress Free Survival, PFS)指标来评价干预措施的有效性。采用Cochrane协作网提供的Revman5.1进行Meta分析,采用相对危险比(relative risk, RR)为合并效应量的统计指标。结果：1.检索结果：共2项随机对照试验,包括546例患者符合纳入标准纳入本研究,其中低剂量组272例,高剂量组274例。按照Cochrane协作网的偏倚风险评价工具进行质量评价,2个研究均为B级。2.统计分析结果低级别胶质瘤患者,低剂量放疗与高剂量放疗相比：后者并未提高总生存率[RR=0.986(95%置信区间,0.822-1.183)]和无进展生存率[RR=1.075(95%置信区间,0.898-1.286)]。结论：1.术后LGG患者的常规放射治疗中,高剂量相比低剂量并未使患者受益。2.高剂量放疗,放疗并发症的发生率高于低剂量放疗。3.影响患者预后的因素包括年龄、临床症状、肿瘤病理类型、肿瘤的部位和大小。更多还原

【Abstract】 Objective:The aim of the study was to conducte a systematic review to analyze on the effect of radiochemotherapy for anaplastic glioma after neurosurgical resection.Meterials and Methods:Articles were searched from the foreign language databases as PubMed, EMBASE and the Coehrane Library, and the Chinese databases as CBM, CNKI, VIP and Wanfang databases with the searching algorithm, from January1998to March2013. The search terms used include’anaplastic glioma’,’anaplastic astrocytoma’,’anaplastic oligodendroglioma’,’anaplastic oligoastrocytoma’,’radiation therapy’ and’chemotherapy’. The search language included English and Chinese. According with the type of study design, study characteristics interventions and outcome measures, we considered all eligible RCTs by comparing evaluation of radiochemotherapy versus radiation alone in anaplastic glioma after neurosurgical resection. In addition, the quality of trials were critically assessed by the criteria from the Cochrane Reviewer Handbook version5.1.0and all these RCTs were graded from A to C. The OS(Overall survival) and PFS(Progress Free Survival) were used to assess the effectiveness of relevant intervention. Stata software was used for statistical analysis. The X2test was used to compare heterogeneity. Sensitivity analysis was used to evaluate the stability and reliability of the results.Results:1. A search of four trials totally with965patients, including480patients of radiochemotherapy,485patients of radiation alone. After assessed by the Cochrane Reviewer Handbook version5.1.0quality criteria all these six RCTs received grade B.2. statistical analysis:(1) There were significant differences associated with OS between radiochemotherapy and radiation alone for anaplastic glioma[HR=0.74(95%CI,0.64—0.86)], and anaplastic oligodendroglioma/anaplastic oligoastr-ocytoma [HR=0.72(95%CI,0.60—0.86)]; There were no significant differences associated with OS between radiochemotherapy and radiation alone for anaplastic astrocytom[HR=0.79(95%CI,0.61—1.02)] (2) There were significant differences associated with PFS between radiochemotherapy and radiation alone for anaplastic glioma[HR=0.67(95%CI,0.56—0.79)];(3) There were significant differences associated with OS and PFS between lp19qLOH and lp19qNLOH in the anaplastic oligodendro-glioma/anaplastic oligoastrocytoma [HR=0.41(95%CI,0.23—0.72) and HR=0.43(95%CI,0.38—0.49)];(4) There were significant differences associated with OS and PFS between radiochemotherapy and radiation alone in the subgroup of patients with lp19qLOH [HR=0.58(95%CI,0.40—0.84) and HR=0.45(95%CI,0.32—0.64)].Conclusions:Radiochemotherapy played a beneficial role in the treatment for anaplastic glioma after neurosurgical resection. It could prolong OS and PFS compared with radiotherapy alone. Patients combined loss of1p19q benefited more from radiochemotherapy, and radiotherapy with PCV increased OS and PFS in this subgroup. But it still needs further large randomized control trials to indicate the role of radiochemotherapy in the treatment for anaplastic astrocytoma, anaplastic oligodendro-glioma/anaplastic oligoastrocytoma or subgroup with1p19qLOH or1p19qNLOH. Objective:The aim of the study was to conducte a systematic review to compare the effect in adult patients treated with low-dose versus high-dose radiotherapy for low-grade glioma after neurosurgical resection.Meterials and Methods:Articles were searched from the foreign language databases as PubMed, EMBASE and the Coehrane Library, and the Chinese databases as CBM, CNKI, VIP and Wanfang databases with the searching algorithm, from database up to March2013. The search terms used include’low grade glioma’,’diffuse astrocytoma’,’oligodendroglioma’,’oligoastrocytoma’and’radiation therapy’. The search language included English and Chinese. According with the type of study design, study characteristics interventions and outcome measures, we considered all eligible RCTs by comparing evaluation of low-dose versus high-dose radiation in low grade glioma after neurosurgical resection. In addition, the quality of trials were critically assessed by the criteria frome the Cochrane Reviewer Handbook version5.1.0and all these RCTs were graded from A to C. The OS(Overall survival) and PFS(Progress Free Survival) were used to assess the effectiveness of relevant intervention. RevMan5.1software was used for statistical analysis. The X2test was used to compare heterogeneity. Sensitivity analysis was used to evaluate the stability and reliability of the results.Results:1. A search of two trials totally with546patients, including272patients with low-dose radiation,274patients with high-dose. After assessed by the Cochrane Reviewer Handbook version5.1.0quality criteria all these two RCTs received grade B.2. Statistical analysis:There were no significant differences associated with OS and PFS between low-dose versus high-dose radiotherapy for low-grade glioma after neurosurgical resection.Conclusions:Results of the systematic review indicated that the difference did not reach the level of significance neither for OS nor for PFS in the high-dose RT arm for low-grade glioma. And it also sugested that slightly higher incidence of radiation necrosis in the high-dose RT arm. The important clinical prognostic factors include age, clinical symptoms, histologic subtype, tumour size and site in the management of patients with LGGs.更多还原