目的:粒子疗法,主要包括碳离子放射治疗(CIRT)和质子束治疗(PBT),与光子放射治疗相比具有剂量分布优势。已被广泛报道为早期非小细胞肺癌(NSCLC)的有希望的治疗方法。然而,其在局部晚期非小细胞肺癌(LA-NSCLC)中的应用相对较少,其疗效和安全性尚无定论。本研究旨在为评估颗粒治疗不能手术的LA-NSCLC的疗效和安全性提供系统证据。
方法:要检索已发表的文献,在PubMed进行了系统的搜索,WebofScience,Embase,和科克伦图书馆,直到2022年9月4日。主要终点是局部控制(LC)率,总生存率(OS),2年和5年无进展生存率(PFS)。次要终点是治疗相关毒性。使用STATA15.1计算合并的临床结果和95%置信区间(CI)。
结果:共纳入19项符合条件的研究,总样本量为851例患者。汇集的数据表明,操作系统,PFS,颗粒治疗2年LA-NSCLC的LC率为61.3%(95%CI=54.7-68.7%),37.9%(95%CI=33.8-42.6%)和82.2%(95%CI=78.7-85.9%),分别。汇集的5年操作系统,PFS,LC率为41.3%(95%CI=27.1-63.1%),25.3%(95%CI=16.3-39.4%),和61.5%(95%CI=50.7-74.6%),分别。按治疗类型分层的亚组分析显示,同步放化疗(CCRT,PBT联合同步化疗)组比PBT和CIRT组有更好的生存效益。3/4级食管炎的发病率,皮炎,颗粒治疗后LA-NSCLC患者的肺炎发生率为2.6%(95%CI=0.4-6.0%),2.6%(95%CI=0.5-5.7%)和3.4%(95%CI=1.4-6.0%),分别。
结论:颗粒疗法在LA-NSCLC患者中显示出良好的疗效和可接受的毒性。
OBJECTIVE: Particle therapy, mainly including carbon-ion radiotherapy (CIRT) and proton beam therapy (PBT), has dose distribution advantages compared to photon radiotherapy. It has been widely reported as a promising treatment method for early non-small cell lung cancer (NSCLC). However, its application in locally advanced non-small cell lung cancer (LA-NSCLC) is relatively rare, and its efficacy and safety are inconclusive. This study aimed to provide systematic evidence for evaluating the efficacy and safety of particle therapy for inoperable LA-NSCLC.
METHODS: To retrieve published literature, a systematic search was conducted in PubMed, Web of Science, Embase, and Cochrane Library until September 4, 2022. The primary endpoints were local control (LC) rate, overall survival (OS) rate, and progression-free survival (PFS) rate at 2 and 5 years. The secondary endpoint was treatment-related toxicity. The pooled clinical outcomes and 95% confidence intervals (CIs) were calculated by using STATA 15.1.
RESULTS: Nineteen eligible studies with a total sample size of 851 patients were included. The pooled data demonstrated that the OS, PFS, and LC rates at 2 years of LA-NSCLC treated by particle therapy were 61.3% (95% CI = 54.7-68.7%), 37.9% (95% CI = 33.8-42.6%) and 82.2% (95% CI = 78.7-85.9%), respectively. The pooled 5-year OS, PFS, and LC rates were 41.3% (95% CI = 27.1-63.1%), 25.3% (95% CI = 16.3-39.4%), and 61.5% (95% CI = 50.7-74.6%), respectively. Subgroup analysis stratified by treatment type showed that the concurrent chemoradiotherapy (CCRT, PBT combined with concurrent chemotherapy) group had better survival benefits than the PBT and CIRT groups. The incidence rates of grade 3/4 esophagitis, dermatitis, and pneumonia in LA-NSCLC patients after particle therapy were 2.6% (95% CI = 0.4-6.0%), 2.6% (95% CI = 0.5-5.7%) and 3.4% (95% CI = 1.4-6.0%), respectively.
CONCLUSIONS: Particle therapy demonstrated promising efficacy and acceptable toxicity in LA-NSCLC patients.