本文選題：前列腺癌/中高危 + 大分割放療�。� 參考：《河北北方學(xué)院》2017年碩士論文

【摘要】：前列腺癌是常見的男性惡性腫瘤之一,在我國的發(fā)病率逐漸上升,美國國家綜合癌癥網(wǎng)絡(luò)(The National Comprehensive Cancer Network,NCCN)和歐洲泌尿外科學(xué)會(huì)(European Association of Urology,EAU)聯(lián)合推薦中高危局限期前列腺癌(PCa)標(biāo)準(zhǔn)治療方法是常規(guī)分割放療聯(lián)合內(nèi)分泌治療。然而,常規(guī)分割放療治療時(shí)間長達(dá)8周左右,治療時(shí)間長,占用醫(yī)療資源多。PCaα/β值較小,根據(jù)放射生物模型,理論上PCa更適合大分割放療,其中低危PCa大分割放療研究較多,且技術(shù)較為成熟。但中高危PCa大分割放療研究報(bào)道較少,且多為小樣本量研究。因此,本文比較中高危局限期PCa大分割放療與常規(guī)分割放療的療效、不良反應(yīng)的差異,為臨床治療提供相應(yīng)依據(jù)。通過計(jì)算機(jī)檢索PubMed數(shù)據(jù)庫,Embase數(shù)據(jù)庫,Web of Science等數(shù)據(jù)庫和相關(guān)期刊論文、中國科技期刊數(shù)據(jù)庫和萬方全文數(shù)據(jù)庫。檢索語言種類限制為英文和中文,檢索時(shí)間不限。搜集有關(guān)中高危局限期PCa大分割放療及常規(guī)分割放療比較的臨床對照研究資料,采用Collaboration協(xié)作網(wǎng)提供的Stata 12.0軟件進(jìn)行Meta分析。兩組間差異采用風(fēng)險(xiǎn)比(hazard ratio,HR)、相對危險(xiǎn)度(risk ratio,RR)及95%可信區(qū)間(95%CI)描述。根據(jù)納入排除和標(biāo)準(zhǔn),最終納入5項(xiàng)包括1621例患者的臨床對照研究資料。Meta分析結(jié)果顯示:兩組的總生存率(HR=1.00,95%CI:0.85-1.17,P=0.9800.05)和生化失敗結(jié)果(RR=0.87,95%CI:0.68-1.12,P=0.2740.05)均相似。與常規(guī)分割放療比較,雖然大分割放療組≥2級(jí)急性胃腸不良反應(yīng)發(fā)生率偏高(RR=1.94,95%CI:1.23-3.06,P=0.0040.05),但3級(jí)及以上急性胃腸不良反應(yīng)兩組無差異,且發(fā)生率低。兩組≥2級(jí)急性泌尿系統(tǒng)不良反應(yīng)(RR=1.03,95%CI:0.92-1.14,P=0.6260.05)、晚期≥2級(jí)胃腸(RR=1.17,95%CI:0.90-1.51,P=0.2380.05)和泌尿系統(tǒng)(RR=1.11,95%CI:0.94-1.30,P=0.2280.05)不良反應(yīng)均相似。亞組分析結(jié)果顯示:當(dāng)常規(guī)分割放療組總劑量≥78Gy時(shí),大分割放療組≥2級(jí)急性胃腸不良反應(yīng)發(fā)生率依舊偏高(RR=1.93,95%CI:1.14-3.29,P=0.0150.05)。而OS率、生化失敗結(jié)果、急性泌尿及晚期不良反應(yīng)兩組亞組分析結(jié)果無顯著差異(P0.05)。中高危局限期PCa大分割放療與常規(guī)分割放療療效相當(dāng),雖然大分割放療組急性胃腸反應(yīng)發(fā)生率略高于常規(guī)分割組,但兩組晚期胃腸和泌尿系統(tǒng)反應(yīng)并無差異,患者可耐受。
[Abstract]:Prostate cancer is one of the common male malignant tumors. The incidence of prostate cancer is increasing in our country. The United States National Comprehensive Cancer Network (The National Comprehensive Cancer Network, NCCN) and the European Society for Department of Urology (European Association of Urology, EAU) jointly recommend the standard treatment for high risk limited stage prostate cancer (PCa) is routine Fractionated radiotherapy combined with endocrine therapy, however, the treatment time of conventional fractionation radiotherapy is 8 weeks long, the treatment time is long and the medical resources are much more.PCa A / beta. According to the radiological biological model, PCa is more suitable for large fractionated radiotherapy, among which, the low risk PCa large fractionation radiotherapy is more and more mature. However, high risk PCa is widely divided. Therefore, this paper compares the effect of PCa large fractionation radiotherapy with conventional fractionated radiotherapy and the difference of adverse reactions in high risk limited period, and provides the basis for clinical treatment. The PubMed database, Embase database, Web of Science database and Chinese periodical full text data are retrieved by computer. Library, Chinese sci-tech journal database and Wanfang full text database. The types of retrieval languages are limited to English and Chinese, and the retrieval time is not limited. The clinical data of comparison of PCa large fractionation radiotherapy and conventional fractionated radiotherapy in middle risk limited period are collected, and Meta analysis is carried out by Stata 12 software provided by Collaboration cooperation network. The differences were hazard ratio (HR), relative risk (risk ratio, RR) and 95% confidence interval (95%CI). According to inclusion exclusion and criteria, the final inclusion of 5 clinical control data including 1621 patients,.Meta analysis showed that the total survival rate (HR=1.00,95%CI:0.85-1.17, P=0.9800.05) and biochemical failure results (R) in the two groups (R R=0.87,95%CI:0.68-1.12, P=0.2740.05) were all similar. Compared with conventional fractionated radiotherapy, although the incidence of acute gastrointestinal adverse reaction (RR=1.94,95%CI:1.23-3.06, P=0.0040.05) was higher in the larger division radiotherapy group (RR=1.94,95%CI:1.23-3.06, P=0.0040.05), there was no difference between the two groups, and the incidence of the acute gastrointestinal adverse reaction was low. Two groups (RR =1.03,95%CI:0.92-1.14, P=0.6260.05), the adverse reactions of the advanced gastrointestinal (RR=1.17,95%CI:0.90-1.51, P=0.2380.05) and urinary system (RR=1.11,95%CI:0.94-1.30, P=0.2280.05) were all similar. The subgroup analysis showed that the incidence of acute gastrointestinal adverse reactions in the large division radiotherapy group was still more than 2 when the total dose of the conventional fractionated radiotherapy group was more than 78Gy. RR=1.93,95%CI:1.14-3.29 (RR=1.93,95%CI:1.14-3.29, P=0.0150.05). But the results of OS, biochemical failure, acute urinary and late adverse reactions were not significantly different (P0.05). The high risk limited period PCa large fractionation radiotherapy was equivalent to the conventional fractionated radiotherapy, although the incidence of acute gastrointestinal reactions in the large fractionated radiotherapy group was slightly higher than that of the conventional division group. However, there was no difference between the two groups in the late gastrointestinal and urinary system response.

【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.25

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