目的综合评价质子治疗(PT)与调强放疗(IMRT)治疗头颈部恶性肿瘤的疗效和安全性。Pubmed,ScienceDirect,Embase,Scopus,和WebofScience进行了系统搜索，以获得关于PT和IMRT结果比较的研究。我们进行了随机效应模型荟萃分析，以估计PT和IMRT之间疗效和安全性结果变量的风险比（HR）和比值比（OR）。从641篇确定的文章中，11项研究符合纳入标准，包括3087名患者（606名接受PT治疗，2481名接受IMRT治疗）。关于毒性分析，与IMRT相比，PT与急性1级恶心减少相关（OR=0.34，95％CI：0.13-0.84，p=0.02）。在2级毒性中，PT在粘膜炎中显示出明显优于IMRT的优势（OR=0.44，p<0.0001），消化不良（OR=0.35，p=0.02），吞咽困难（OR=0.36，p<0.0001），疲劳(OR=0.29，p=0.001)，疼痛（OR=0.34，p=0.01），和体重减轻（OR=0.54，p=0.02）。与IMRT相比，质子治疗在3级吞咽困难发生率（OR=0.44，p<0.0001）中也显示出增加的安全性。PT在多个时间点表现出与IMRT相比改善的总生存期（OS）：1年OS（HR=0.43，p=0.02），2年OS（HR=0.44，p<0.0001），和5年OS（HR=0.78，p=0.004）。在无病生存率（DFS）方面，PT在2年DFS（HR=0.65，p=0.03）和5年DFS（HR=0.81，p=0.03）时也显示出改善的结果。质子治疗表现出优越的总生存率（OS），无病生存率（DFS），与IMRT相比，局部控制率（LCR）更好。数据还显示PT患者的安全性更好，特别是当涉及2级急性毒性事件时。
To comprehensively evaluate the therapeutic efficacy and safety when utilizing proton therapy (PT) versus intensity-modulated radiation therapy (IMRT) in head and neck cancer patients. Pubmed, ScienceDirect, Embase, Scopus, and Web of Science were systematically searched for studies on comparative PT and IMRT outcomes. We performed a random effect model meta-analysis to estimate the hazard ratio (HR) and odds ratio (OR) for efficacy and safety outcome variables between PT and IMRT. From 641 identified articles, 11 studies met the inclusion criteria, comprising 3087 patients (606 treated with PT and 2481 with IMRT). On toxicity analysis, PT is associated with decreased acute grade 1 nausea (OR = 0.34, 95% CI: 0.13-0.84, p = 0.02) compared to IMRT. In grade 2 toxicity, PT showed significant advantages over IMRT in mucositis (OR = 0.44, p < 0.0001), dysgeusia (OR = 0.35, p = 0.02), dysphagia (OR = 0.36, p < 0.0001), fatigue (OR = 0.29, p = 0.001), pain (OR = 0.34, p = 0.01), and weight loss (OR = 0.54, p = 0.02). Proton therapy also exhibited increased safety in grade 3 dysphagia incidence (OR = 0.44, p < 0.0001) compared to IMRT. PT demonstrated improved overall survival (OS) compared to IMRT across multiple time points: 1-year OS (HR = 0.43, p = 0.02), 2-year OS (HR = 0.44, p < 0.0001), and 5-year OS (HR = 0.78, p = 0.004). In terms of disease-free survival (DFS), PT also showed improved outcomes at 2-year DFS (HR = 0.65, p = 0.03) and 5-year DFS (HR = 0.81, p = 0.03). Proton therapy demonstrated superior overall survival (OS), disease-free survival (DFS), and better local control rate (LCR) compared to IMRT. The data also showed better safety outcomes in PT patients, particularly when involving grade 2 acute toxicity events.
