螺旋刀和傳統放射治療於乳癌輔助性放射治療之急性副作用（毒性）：系統性文獻回顧與統合分析

背景：乳癌輔助性放射治療在治療期間常會誘發急性及晚期副作用，為降低副作用效應，臨床常以螺旋刀提供以螺旋式的強度調控放射治療，以便更均勻分散乳房周圍皮膚劑量，但其效果仍有限，加上其急性副作用（毒性）的影響仍尚未明暸，因此如何解決並提供病患更好的治療方式是目前臨床急需解決的問題。目的：本研究透過系統性回顧與統合分析的方式，在乳癌患者手術後接受輔助性放射治療，探討螺旋刀與傳統放射治療於急性副作用（毒性）的風險。方法：我們搜尋PubMed、Cochrane Library等醫學資料庫並將搜索日至2021年11月回溯既往所有隨機對照試驗的文獻進行統合分析，其搜索字詞為Population：≥18歲且需接受乳房外科手術後接受放射線輔助治療，Intervention：螺旋刀，Compare：傳統放射治療，Outcome：急性及晚期副作用。其餘guild line check point（list）遵循PRISMA 2009程序進行。統合分析軟體我們使用Revmen5.3及選用random-effects model進行統合分析。結果：總共搜尋390篇文章，其中根據摘要排除與全文閱讀，最終納入2篇文章分析。總共分析489位受試者（平均年齡56歲），分別為螺旋刀251人，傳統放射治療238人。統合分析結果顯示乳癌接受輔助性放射治療後急性副作用（毒性）放射性皮膚炎相對風險為1.06（CI 0.80-1.39）、治療後乳房或胸壁的疼痛反應為0.79（CI 0.58-1.01）、治療後淋巴水腫反應為0.76（CI 0.39-1.48），其結果顯示RR值在採用螺旋刀治療上都有達到降低急性及晚期副作用效果但都未達統計顯著差異性。結論：至少目前為止以我們的數據來看，統合分析結果證實乳癌患者手術後接受輔助性放射治療，在螺旋刀或傳統放射治療有相似的急性副作用（毒性）的風險。

關鍵字

急性副作用；乳癌輔助放射治療；統合分析；螺旋刀

並列摘要

Background: Breast cancer adjuvant radiation therapy often induces acute and late side effects during treatment, in order to reduce the effect of side effects, the clinicl often provides spiral-shaped intensity control radiation therapy with a Helical tomotherapy to more evenly disperse the dose of skin around the breast, but its effect is still limited, and the impact of its acute side effects is still unknown, so how to solve and provide better treatment for patients is an urgent problem to be solved in the current clinic. Purpose: In this study, through systematic review and integrated analysis, patients with breast cancer received adjuvant radiation therapy after surgery to explore the risk of acute side effects of Helical tomotherapy and conventional radiation therapy. Method: We search medical databases such as PubMed and Cochrane Library and searched for a consolidated analysis of the literature of all previous randomized controlled trails by November 2021. The search terms are polymer ≥ 18 years of age who require adjuvant radiation after breast surgery, Intervention: Helical tomotherapy, Compare: conventional radiotherapy, Outcome: acute and advanced side effects. The rest of the guild line check point (list) follows the PRISMA 2009 program. Integrated analysis software we use Revmen 5.3 and the random-effects model for integrated analysis. Results: A total of 390 articles were searched, of which abstract exclusion and full reading were included, and finally two articles were analyzed. A total of 489 subjects (mean age 56 year-old) were analyzed, 251 people were screw Helical tomotherapy and 238 people were treated with conventional radiotherapy. The results of the combined analysis showed that relative risk (RR) of acute side effects of radiation dermatitis after breast cancer receiving adjuvant radiation therapy was 1.06 (95 % CI:0.80~ 1.39), the pain response of the breast or chest wall after treatment was 0.79 (95 % CI:0.58~1.01), and the lymphedema response after treatment was 0.76 (95 % CI:0.39~1.48), the results showed that the RR had the effect of reducing acute and late-phase side effects in the treatment with Helical tomotherapy, but did not achieve statistically significant differences. Conclusions: At least so far, based on our data, the results of a Mata-analysis confirm that patients with breast cancer who receive adjuvant radiation therapy after surgery have a similar risk of acute side effects in Helical tomotherapy or conventional radiotherapy.

並列關鍵字

Acute toxicity ； Adjuvant breast radiotherapy ； Meta-analysis ； Helical tomotherapy

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