Candra Novi Ricardo Sibarani, Siti Salima, Nicholas Adrianto
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引用次数: 0
摘要
目的:本综述评估EBRT + VBT与单独VBT治疗中至高危子宫内膜癌的疗效和安全性。方法:使用PubMed、EMBASE、ProQuest、Ovid和Scopus进行系统综述和荟萃分析(截至2025年2月18日)。比较EBRT + VBT与单独VBT的研究被纳入。主要结局是盆腔复发率,次要结局包括远处复发率、总生存期和毒性。进行数据提取、偏倚风险评估(rob2、ROBINS-I)和meta分析(RevMan中的随机效应模型)。使用GRADE评价证据的确定性。普洛斯彼罗注册号:CRD420250654411。结果:8项研究包括2,672例患者符合纳入标准(1,347例接受EBRT + VBT;1325人仅患有VBT)。EBRT + VBT可显著降低盆腔复发(OR 0.14, p = 0.001),但在阴道复发(OR 0.25, p = 0.14)、远处转移(OR 0.78, p = 0.45)或总生存率(HR 0.82, p = 0.29, I2 = 72%)方面无显著差异。EBRT + VBT与较高的胃肠道、泌尿生殖系统和血液学毒性相关。结论:EBRT + VBT可改善盆腔控制,但不提高生存率,并增加毒性。单独的VBT仍然是一个可行的选择,强调个性化治疗策略的必要性。
Comparative efficacy and safety of vaginal brachytherapy versus combined pelvic external beam radiotherapy and vaginal brachytherapy in managing intermediate to high-risk endometrial cancer: a systematic review and meta-analysis.
Purpose: This review assesses the efficacy and safety of EBRT + VBT versus VBT alone in intermediate- to high-risk endometrial cancer.
Methods: A systematic review and meta-analysis were conducted using PubMed, EMBASE, ProQuest, Ovid, and Scopus (until February 18, 2025). Studies comparing EBRT + VBT to VBT alone were included. The primary outcome was pelvic recurrence rate, while secondary outcomes included distant recurrence, overall survival, and toxicity. Data extraction, risk of bias assessment (RoB-2, ROBINS-I), and meta-analysis (random-effects models in RevMan) were performed. Certainty of evidence was evaluated using GRADE. PROSPERO registration: CRD420250654411.
Results: Eight studies comprising 2,672 patients met inclusion criteria (1,347 received EBRT + VBT; 1,325 had VBT alone). EBRT + VBT significantly reduced pelvic recurrence (OR 0.14, p = 0.001) but showed no difference in vaginal recurrence (OR 0.25, p = 0.14), distant metastasis (OR 0.78, p = 0.45) or overall survival (HR 0.82, p = 0.29, I2 = 72%). EBRT + VBT was associated with higher gastrointestinal, genitourinary, and hematologic toxicity.
Conclusion: EBRT + VBT improves pelvic control but does not enhance survival and increases toxicity. VBT alone remains a viable option, highlighting the need for individualized treatment strategies.
期刊介绍:
As the official publication of the National Cancer Institute, Cairo University, the Journal of the Egyptian National Cancer Institute (JENCI) is an open access peer-reviewed journal that publishes on the latest innovations in oncology and thereby, providing academics and clinicians a leading research platform. JENCI welcomes submissions pertaining to all fields of basic, applied and clinical cancer research. Main topics of interest include: local and systemic anticancer therapy (with specific interest on applied cancer research from developing countries); experimental oncology; early cancer detection; randomized trials (including negatives ones); and key emerging fields of personalized medicine, such as molecular pathology, bioinformatics, and biotechnologies.