背景:围绕口咽的复杂解剖结构使质子治疗(PT),特别是强度调制PT(IMPT),由于其能够减少受照射的健康组织的体积,因此具有潜在的吸引力。剂量学改善可能不会转化为临床相关的益处。随着结果数据的出现,我们的目的是评估口咽癌(OC)PT后的生活质量(QOL)和患者报告结局(PROs)的证据.
方法:我们搜索了PubMed和Scopus电子数据库(日期:2023年2月15日),以确定对OC的PT后QOL和PRO的原始研究。通过跟踪最初选择的研究的引用,我们在搜索策略中采用了流动策略。提取报告以获取人口统计信息,主要结果,和临床和剂量因子相关。使用NIH的质量评估工具进行质量评估,用于观察性队列和横断面研究。在编写本报告时遵循了PRISMA准则。
结果:选择了7份报告,包括最近发表的一篇从引文跟踪中捕获的论文。五个比较了PT和基于光子的治疗,尽管没有一项是随机对照试验。大多数具有显著差异的终点都倾向于PT,包括口干症,咳嗽,需要营养补充剂,熟食症,食物味道,食欲,和一般症状。然而,一些终点支持基于光子的治疗(性症状)或没有显着差异(例如,疲劳,疼痛,睡眠,口腔溃疡)。PT后,PRO和QOL有所改善,但似乎没有恢复到基线。
结论:证据表明,与基于光子的治疗相比,PT导致的QOL和PRO恶化更少。由于非随机研究设计而产生的偏见仍然是得出坚定结论的障碍。PT是否具有成本效益应进一步调查。
BACKGROUND: Complex anatomy surrounding the oropharynx makes proton therapy (PT), especially intensity-modulated PT (IMPT), a potentially attractive option due to its ability to reduce the volume of irradiated healthy tissues. Dosimetric improvement may not translate to clinically relevant benefits. As outcome data are emerging, we aimed to evaluate the evidence of the quality of life (QOL) and patient-reported outcomes (PROs) following PT for oropharyngeal carcinoma (OC).
METHODS: We searched PubMed and Scopus electronic databases (date: 15 February 2023) to identify original studies on QOL and PROs following PT for OC. We employed a fluid strategy in the search strategy by tracking citations of the initially selected studies. Reports were extracted for information on demographics, main results, and clinical and dose factor correlates. Quality assessment was performed using the NIH\'s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The PRISMA guidelines were followed in the preparation of this report.
RESULTS: Seven reports were selected, including one from a recently published paper captured from citation tracking. Five compared PT and photon-based therapy, although none were randomized controlled trials. Most endpoints with significant differences favored PT, including xerostomia, cough, need for nutritional supplements, dysgeusia, food taste, appetite, and general symptoms. However, some endpoints favored photon-based therapy (sexual symptoms) or showed no significant difference (e.g., fatigue, pain, sleep, mouth sores). The PROs and QOL improve following PT but do not appear to return to baseline.
CONCLUSIONS: Evidence suggests that PT causes less QOL and PRO deterioration than photon-based therapy. Biases due to the non-randomized study design remain obstacles to a firm conclusion. Whether or not PT is cost-effective should be the subject of further investigation.