瘢痕疙瘩术后不同放射治疗方案的Meta分析
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摘要
目的探讨不同放射治疗方案对瘢痕疙瘩术后治疗的有效率、复发率及并发症等的影响。方法检索自1990年1月至2018年8月瘢痕疙瘩术后联合放射治疗的相关文献,数据库包括PubMed、EMbase、Cochrane library、CNKI、VIP(维普期刊)、万方医学网等,并提取相关试验数据,纳入Meta分析。结果对瘢痕疙瘩术后放射治疗时机的研究共纳入10篇文献,根据术后放射治疗开始时间,分为术后72 h内与术后72 h后放射治疗组,两组有效率比较,其差异具有统计学意义(P<0.000 01),OR=10.80 [5.92,19.69];瘢痕疙瘩术后放射治疗分割剂量纳入7篇文献,根据不同分割剂量分为两组,即小分割剂量组(单次放射治疗剂量≤2 Gy)与大分割剂量组(单次放射剂量>2 Gy),两组有效率比较,其差异具有统计学意义(P<0.000 01),OR=0.25 [0.16,0.38];大分割剂量组与小分割剂量组并发症发生率具有统计学意义(P<0.000 01),OR=3.73 [2.44,5.71];两组局部红斑发生率比较,无统计学意义(P>0.05);局部色素沉着发生率比较,具有统计学意义(P<0.05),OR=2.36 [1.08,5.19]。结论瘢痕疙瘩切除术后72 h内开始放射治疗,其效果优于72 h后开始放射治疗;大分割剂量组治疗效果优于小分割剂量组。大分割剂量组治疗后,并发症发生率总体高于小分割剂量组,其中局部红斑发生率无明显差异。
Objective To explore my meta-analysis the effects of different radiotherapy regimens on the effective rate, recurrence rate, and complications after keloid resection surgery. Methods Related Chinese and English literature of radiotherapy after keloid resection surgery were reviewed from January 1990 to August 2018. The database included PubMed, EMbase, Cochrane Library, CNKI, VIP and Wanfang. Relevant experimental data was extracted and included in meta-analysis. Results Ten articles about radiotherapy treatment opportunities after keloid resection surgery were involved in the study. According to the start time of the radiotherapy treatment, the articles were divided into a radiotherapy treatment within 72 hours group and radiotherapy treatment 72 hours after surgery group. The effective rate was statistically significant between the 2 groups(P<0.000 01), OR=10.80 [5.92,19.69]. Seven articles about fractionated radiotherapy dosage were included. According to the various fractionated doses, the original literature was divided into a small fractionated dose group(single radiotherapy dose ≤2 Gy) and large fractionated dose group(single radiotherapy dose >2 Gy). The difference of the effective rate between the two groups was statistically significant(P<0.000 01), OR=0.25 [0.16, 0.38]. The incidence rate of complications between the two groups was statistically significant(P<0.000 01), OR=3.73 [2.44, 5.71]. There was no statistical significance in the incidence rate of local erythema between the groups(P>0.05). The incidence rate of local pigmentation between the two groups was statistically significant(P<0.05), OR=2.36 [1.08,5.19]. Conclusion The efficacy of radiotherapy within 72 hours was better than that after 72 hours. The therapeutic efficacy of the large fractionated dose group was greater than that of the small fractionated dose group. After large fractionated dose treatment, the incidence rate of complications was higher than that of small fractionated dose treatment. There was no significant difference in the incidence of local erythema. The incidence rate of hyperpigmentation in the large fractionated dose group was higher than that of the small fractionated dose group. No significant difference was evident in the recurrence rate of keloid in predilection and other sites.
Objective To explore my meta-analysis the effects of different radiotherapy regimens on the effective rate, recurrence rate, and complications after keloid resection surgery. Methods Related Chinese and English literature of radiotherapy after keloid resection surgery were reviewed from January 1990 to August 2018. The database included PubMed, EMbase, Cochrane Library, CNKI, VIP and Wanfang. Relevant experimental data was extracted and included in meta-analysis. Results Ten articles about radiotherapy treatment opportunities after keloid resection surgery were involved in the study. According to the start time of the radiotherapy treatment, the articles were divided into a radiotherapy treatment within 72 hours group and radiotherapy treatment 72 hours after surgery group. The effective rate was statistically significant between the 2 groups(P<0.000 01), OR=10.80 [5.92,19.69]. Seven articles about fractionated radiotherapy dosage were included. According to the various fractionated doses, the original literature was divided into a small fractionated dose group(single radiotherapy dose ≤2 Gy) and large fractionated dose group(single radiotherapy dose >2 Gy). The difference of the effective rate between the two groups was statistically significant(P<0.000 01), OR=0.25 [0.16, 0.38]. The incidence rate of complications between the two groups was statistically significant(P<0.000 01), OR=3.73 [2.44, 5.71]. There was no statistical significance in the incidence rate of local erythema between the groups(P>0.05). The incidence rate of local pigmentation between the two groups was statistically significant(P<0.05), OR=2.36 [1.08,5.19]. Conclusion The efficacy of radiotherapy within 72 hours was better than that after 72 hours. The therapeutic efficacy of the large fractionated dose group was greater than that of the small fractionated dose group. After large fractionated dose treatment, the incidence rate of complications was higher than that of small fractionated dose treatment. There was no significant difference in the incidence of local erythema. The incidence rate of hyperpigmentation in the large fractionated dose group was higher than that of the small fractionated dose group. No significant difference was evident in the recurrence rate of keloid in predilection and other sites.
引文
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[20]LUO S,Benathan M,Raffoul W,et al.Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions[J].Plast Reconstr Surg,2001,107(1):87-96.
[21]MCKEOWN S R,HATFIELD P,PRESTWICH R J,et al,Radiotherapy for benign disease;assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation[J].Br JRadiol,2015,88(1056):20150405.
[22]李晓丹.瘢痕疙瘩术后放射治疗进展[J].江西医药,2013,48(5):462-464,468.
[23]KIM K,SON D,KIM J.Radiation therapy following total keloidectomy:a retrospective study over 11 years[J].Arch Plast Surg,2015,42(5):588-595.
[24]王庆国,李晓梅,张敏,等.107例瘢痕疙瘩术后两种分割剂量放疗疗效分析[J].北京大学学报(医学版),2014,46(1):169-172.
[2]王维佳,谢亦欣,杨斌,等.手术切除联合浅层X线放疗在瘢痕疙瘩治疗中的应用[J].组织工程与重建外科,2016,12(1):41-43.
[3]周晓娟,任若梅,张洪,等.瘢痕术后电子线放射治疗的疗效观察[J].华西医学,2005,20(2):323-324.
[4]庄翔,任光国,杨家林.瘢痕疙瘩术后放疗的疗效探讨[J].中华医学美学美容杂志,2003,9(2):115.
[5]李涛,朱卫国,彭进,等.瘢痕疙瘩术后放疗的时间效应探讨[J].西部医学,2004,16(4):327-328.
[6]温本,刘培光,何梓,等.手术联合早期放疗治疗瘢痕疙瘩[J].山西医药杂志,2005,34(5):368-369.
[7]苏小岩,王建国,杨继元.瘢痕疙瘩117例术后放疗临床分析[J].湖北省卫生职工医学院学报,2004,17(4):36-37,49.
[8]贺敏.瘢痕疙瘩术后后装敷贴放疗时机的临床探讨[J].实用癌症杂志,2007,22(6):668-669.
[9]罗定泰,罗定安,陈学杰,等.瘢痕疙瘩术后放射治疗的疗效探讨[J].临床外科杂志,1999,7(5):293.
[10]马亚杰,王章恩,夏雅铭.瘢痕疙瘩手术后早期磷-32敷贴放疗疗效对比分析[J].中国实用医药,2013,8(23):156-157.
[11]吕敏.不同分割剂量电子线辅助放疗在瘢痕疙瘩中的治疗效果[J].当代医学,2017,23(11):100-101.
[12]查建栋,张卓.瘢痕疙瘩术后常规分割放疗与大分割放疗疗效比较[D].大连医科大学,2015.!!!!!!!!!!!!!!!!!!!
[13]李辉正,曹莫.瘢痕疙瘩术后电子线治疗70例回顾研究[D].河北医科大学,2011.
[14]程洋,张临泉.增生性瘢痕术后放疗的疗效观察[J].中国现代医生,2008,46(33):61-63.
[15]DUAN Q,LIU J,LUO Z,et al.Postoperative brachytherapy and electron beam irradiation for keloids:A single institution retrospective analysis[J].Mol Clin Oncol,2015,3(3):550-554.
[16]邵卫仙,刘亚洲,苗慧,等.瘢痕瘤术后不同分割放射治疗的疗效与影响因素[J].世界临床医学,2017,11(23):67-68.
[17]LEE H J,JANG Y J.Recent understandings of biology,prophylaxis and treatment strategies for hypertrophic scars and keloids[J].Int JMol Sci,2018,19(3):E711.
[18]OGAWA R,AKAISHI S,KURIBAYASHI S,et al.Keloids and hypertrophic scars can now be cured completely:recent progress in our understanding of the pathogenesis of keloids and hypertrophic scars and the most promising current therapeutic strategy[J].JNippon Med Sch,2016,83(2):46-53.
[19]LEVENTHAL D,FURR M,REITER D.Treatment of keloids and hypertrophic scars:a meta-analysis and review of the literature[J].Arch Facial Plast Surg,2006,8(6):362-368.
[20]LUO S,Benathan M,Raffoul W,et al.Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions[J].Plast Reconstr Surg,2001,107(1):87-96.
[21]MCKEOWN S R,HATFIELD P,PRESTWICH R J,et al,Radiotherapy for benign disease;assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation[J].Br JRadiol,2015,88(1056):20150405.
[22]李晓丹.瘢痕疙瘩术后放射治疗进展[J].江西医药,2013,48(5):462-464,468.
[23]KIM K,SON D,KIM J.Radiation therapy following total keloidectomy:a retrospective study over 11 years[J].Arch Plast Surg,2015,42(5):588-595.
[24]王庆国,李晓梅,张敏,等.107例瘢痕疙瘩术后两种分割剂量放疗疗效分析[J].北京大学学报(医学版),2014,46(1):169-172.