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The Changing Therapeutic Role of Chemo-radiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma from Two/Three-Dimensional Radiotherapy to Intensity-Modulated Radiotherapy: A Network Meta-Analysis.
从二维/三维放射治疗到调强放射治疗局部晚期鼻咽癌化疗放射治疗作用的变化: 一项网络荟萃分析。
chemotherapy intensity-modulated radiotherapy nasopharyngeal carcinoma network meta-analysis radiotherapy survival outcome
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摘要

Purpose: We used randomized trials of radiotherapy (RT) with or without chemotherapy in non-metastatic nasopharyngeal carcinoma to investigate the survival benefit of chemoradiotherapy regimens between two/three-dimensional radiotherapy (2D/3D RT) and intensity-modulated radiotherapy (IMRT). Methods: Overall, 27 trials and 7,940 patients were included. Treatments were grouped into seven categories including RT alone, induction chemotherapy (IC) followed by RT (IC-RT), RT followed by adjuvant chemotherapy (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concurrent chemo-radiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). To distinguish between 2D/3D RT and IMRT, three categories in IMRT were newly added, including CRT in IMRT, IC-CRT in IMRT, and CRT-AC in IMRT. The P score was used to rank the treatments. Results: Both fixed- and random-effects frequentist and Bayesian network meta-analysis models were applied, which provided similar results and the same ranking. IC-CRT was the most effective regimen compared with CRT-AC and CRT in the IMRT era for overall survival (OS) (HR, 95% CI, IC-CRT vs. CRT-AC, 0.61 (0.45, 0.82); IC-CRT vs. CRT 0.65 (0.47, 0.91)), progression-free survival (PFS) (0.69 (0.54, 0.88); 0.63 (0.49, 0.80)), and distant metastasis-free survival (DMFS) (0.58 (0.28, 1.21); 0.60 (0.42, 0.85)). CRT-AC achieved the highest survival benefit compared with CRT, and IC-CRT for loco-regional relapse-free survival (LRRFS) (0.44 (0.15, 1.28); 0.72 (0.22, 2.33)). Among these 10 categories, after distinguishing between 2D/3D RT and IMRT, IC-CRT in IMRT ranked first for OS, PFS, and DMFS, and CRT-AC in IMRT ranked first for LRRFS. Conclusion: IC-CRT should be the most suitable regimen for loco-regionally advanced NPC in the IMRT era.

译文

目的: 我们使用放射治疗的随机试验在非转移性鼻咽癌中进行或不进行化疗,以调查放化疗方案在二维/三维放疗 (2D/3D RT) 和调强放疗 (IMRT) 之间的生存益处。方法: 总共纳入了 27 项试验和 7,940 名患者。治疗被分为七类,包括 RT 单独治疗,诱导化疗 (IC),然后是 RT (IC-RT),RT 之后是辅助化疗 (RT-AC), IC 后跟 RT 后跟 AC (IC-RT-AC),同期放化疗 (CRT),IC 后跟 CRT (IC-CRT), 和 CRT 后接 AC (CRT-AC)。为了区分 2D/3D RT 和 IMRT,IMRT 新增了三个类别,包括 IMRT 中的 CRT 、 IMRT 中的 IC-CRT 和 IMRT 中的 CRT-AC。P 评分用于对治疗进行排序。结果: 采用固定效应和随机效应的频数分析和贝叶斯网络荟萃分析模型,得到了相似的结果和相同的排序。在 IMRT 时代,与 CRT-AC 和 CRT 相比,IC-CRT 是最有效的总生存期 (OS) 方案 (HR,95% CI,IC-CRT vs. CRT-AC,0.61 (0.45,0.82); IC-CRT 对比 CRT 0.65 (0.47,0.91)),无进展生存期 (PFS) (0.69 (0.54,0.88); 0.63(0.49,0.80)),和无远处转移生存 (DMFS) (0.58 (0.28,1.21); 0.60 (0.42,0.85))。与 CRT 相比,CRT-AC 获得了最高的生存获益,并且 IC-CRT 的局部无复发生存 (LRRFS) (0.44 (0.15,1.28); 0.72 (0.22, 2.33))。在这 10 个类别中,在区分了 2D/3D RT 和 IMRT 之后,IMRT 中的 IC-CRT 在 OS 、 PFS 和 DMFS 中排名第一, 而 CRT-AC 在 IMRT 中排名第一的是 lrfs。结论: 在 IMRT 时代,IC-CRT 应该是最适合局部晚期 NPC 的方案。

intensity modulated radiotherapy

肿瘤 放疗 治疗方法
概述  :  

调强放射放疗(IMRT)是指在三维适形照射的基础上对照射野截面内诸点输出剂量按要求的方式进行调整,经过旋转照射使射线剂量在体内空间分布与病变一致,形成高剂量区。这样不仅使靶区接受较高剂量的照射,提高了肿瘤控制率,而且降低周围正常组织的受量,减少了正常组织的损伤,改善患者的生活质量。调强适形放射治疗是目前最为先进的肿瘤放射治疗技术,在我国只有少数肿瘤治疗中心能开展。IMRT发展的历史仅10余年,真正用于临床病人放疗时间也不长,但已显示出显著的优越性。已被国际放疗界公认为目前最好的放疗技术。其目

Intensity   英 /ɪnˈtensəti/   美 /ɪnˈtensəti/

释    义   n. 强度;强烈;[电子] 亮度;紧张;复数 intensities

同根词   intense adj. 强烈的;紧张的;非常的;热情的

               intensive adj. 加强的;集中的;透彻的;加强语气的

               intensional adj. 内涵的;紧张的

               intensely adv.强烈地;紧张地;热情地

               intensive n. 加强器

               intension n. 强度,烈度;加强,加剧;紧张

               intensify vi. 增强,强化;变激烈

               intensify vt. 使加强,使强化;使变激烈

例    句   Without that level of intensity, there is no loyalty. 如果没有这种层次的强度,那就没有忠诚可言。

 

Modulated   /'mɔdjuleitid/

释    义   adj. 已调的;被调的;v. 调整,调节;吟咏;改变(嗓音的)音量(modulate的过去分词)

同根词   modification n. 修改,修正;改变

               modulation n. [电子] 调制;调整

               modulate vi. 调制;转调

               modulate vt. 调节;(信号)调制;调整

例    句   Photosynthesis is modulated by oxygen, and we have an oxygen-insensitive hydrogenase that we think will totally change this process. 光合作用受氧调节,而我们使用的对氧不敏感的氢化酶,将完全改变这一过程。

 

Radiotherapy   英 /ˌreɪdiəʊˈθerəpi/   美 /ˌreɪdioʊˈθerəpi/

释    义   n. [特医] 放射疗法

同根词   radiosensitive adj. 对放射线敏感的

               radioscopy n. 放射线透视;X光透视

例    句   He expects to undergo radiotherapy as well, and has cancelled all travel plans for three months. 他打算接受放疗,并已经取消三个月的所有旅行计划。

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