Radiotherapy combined with surgical treatment for gastric cancer: a Meta analysis
10.3781/j.issn.1000-7431.2010.04.008
- VernacularTitle:放疗联合手术治疗胃癌的Meta分析
- Author:
Liyun GUO
;
Bin MA
;
Kehu YANG
;
Xiaohu WANG
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Radiotherapy;
Surgical procedure,operative;
Randomized controlled trial;
Meta-analysis
- From:
Tumor
2010;(4):303-309
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the effectiveness and safety of radiotherapy combined with surgery for gastric cancer compared with single surgery. Methods:We retrieved relevant randomized controlled trails in Cochrane Library (Issue 2, 2009), PubMed (Jan 1966-Jun 2009), EMBASE (Jan 1974-Jun 2009), Chinese Biomedical Literature Database (Jan 1978-Jun 2009), Chinese Science and Technology Periodicals Database (Jan 1989-Jun 2009) ,China National Knowledge Infrastructure (Jan 1994 to Jun 2009) and Wanfang database (Jan 1997-Jun 2009). Two researchers assessed the quality of included randomized controlled trials (RCT) and extracted data independently. The RevMan 5.0 software was used for Meta-analysis. Results:Nine RCTs including 1 548 patients were selected for Meta analysis. Five RCTs were related with comparison of preoperative radiotherapy plus surgery with single surgery. Two RCTs were about the comparison of surgery plus perioperative radiotherapy with single surgery. Two RCTs were the comparative studies between surgery plus postoperative radiotherapy and single surgery. The Meta analysis results showed that: (1)compared with surgery alone, preoperative radiotherapy combined with surgery can increase 3 years [OR = 1.78, 95% confidence interal (CI):1.14-2.78], 5 years (OR = 1.67, 95%CI :1.22-2.29),and 10 years (OR = 1.64, 95%CI 1.03-2.60) survival rate,and reduce the tumor recurrent rate(OR = 0.59, 95%CI :0.37-0.92) and metastasis rate (OR= 0.44, 95%CI :0.27-0.73); (2) The tumor recurrent rates (OR = 0.19,95%CI :0.03-1.14 )and tumor metastasis rates (OR = 0.09, 95%CI :0.00-1.77)had no difference between single surgery group and peri-operative radiotherapy plus surgery group;(3) Postoperative radiotherapy compared with surgery had no significant effects on 1 year (OR = 0.83, 95%CI :0.60-1.15) and 3 years (OR = 0.75, 95%CI :0.51-1.11) survival rate compared with single surgery, but the 5 years (OR = 0.57,95%CI :0.34-0.95) survival rate of the patients who received surgery alone was higher than those who received combined therapy. No difference of the tumor recurrence rate(OR=0.59,95%CI :0.33-1.05) and tumor metastasis rate (OR=0.90,95%CI:0.51-1.59) were observed between the two groups. Conclusion:Preoperative radiotherapy combined with surgery is more rational and effective than surgery alone in the treatment of gastric cancer. However in terms of the clinical effects of perioperative or postoperative radiotherapy combined with surgery, more RCTs with larger samples and higher quality need to be carried out to make further verification.
