目的:神经母细胞瘤是儿童常见的颅外实体瘤。最近,已实施多种治疗,包括碘-131-间碘苄基胍放射(131I-MIBG)治疗.然而,不同研究的疗效和安全性结果差异很大.这项荟萃分析的目的是评估131I-MIBG治疗神经母细胞瘤的有效性和安全性,并为临床决策提供证据和提示。
方法:Medline,检索EMBASE数据库和Cochrane图书馆进行相关研究。纳入了利用131I-MIBG治疗神经母细胞瘤的合格研究。汇总结果(反应率,不良事件发生率,生存率)使用随机效应模型或考虑异质性的固定效应模型计算。
结果:共分析了26项临床试验,包括883例患者。客观反应的汇总率,疾病稳定,进行性疾病,131I-MIBG单药治疗的轻微反应为39%,31%,22%和15%,分别。131I-MIBG联合其他疗法的合并客观缓解率为28%。合并的1年生存率和5年生存率分别为64%和32%。MIBG单药治疗研究中血小板减少和中性粒细胞减少的合并发生率分别为53%和58%。在131I-MIBG联合其他疗法的研究中,血小板减少和中性粒细胞减少的合并发生率分别为79%和78%.
结论:131I-MIBG单独治疗或联合其他疗法对神经母细胞瘤的临床治疗结果有效,临床推荐个体化131I-MIBG.
OBJECTIVE: Neuroblastoma is a common extracranial solid tumor of childhood. Recently, multiple treatments have been practiced including Iodine-131-metaiodobenzylguanidine radiation (131I-MIBG) therapy. However, the outcomes of efficacy and safety vary greatly among different studies. The aim of this meta-analysis is to evaluate the efficacy and safety of 131I-MIBG in the treatment of neuroblastoma and to provide evidence and hints for clinical decision-making.
METHODS: Medline, EMBASE database and the Cochrane Library were searched for relevant studies. Eligible studies utilizing 131I-MIBG in the treatment of neuroblastoma were included. The pooled outcomes (response rates, adverse events rates, survival rates) were calculated using either a random-effects model or a fixed-effects model considering of the heterogeneity.
RESULTS: A total of 26 clinical trials including 883 patients were analyzed. The pooled rates of objective response, stable disease, progressive disease, and minor response of 131I-MIBG monotherapy were 39%, 31%, 22% and 15%, respectively. The pooled objective response rate of 131I-MIBG in combination with other therapies was 28%. The pooled 1-year survival and 5-year survival rates were 64% and 32%. The pooled occurrence rates of thrombocytopenia and neutropenia in MIBG monotherapy studies were 53% and 58%. In the studies of 131I-MIBG combined with other therapies, the pooled occurrence rates of thrombocytopenia and neutropenia were 79% and 78%.
CONCLUSIONS: 131I-MIBG treatment alone or in combination of other therapies is effective on clinical outcomes in the treatment of neuroblastoma, individualized 131I-MIBG is recommended on a clinical basis.