用GRADE方法确定成年人进行质子疗法的基于证据的指示
Carolina Moltó-Puigmartí1, Jordi Giralt2,3, Lucía Alonso García1
1AQuAS: Agència de Qualitat i Avaluació Sanitàries de Catalunya (Evaluation Department), Barcelona, Spain.
概括
与传统的X射线放射治疗 (XRT) 相比,质子疗法 (PT) 显示出可变的结果,一些癌症类型看起来很有前途. 需要更多高质量的研究来确认PTPT.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 在瘤学瘤学.
背景情况:
- 质子疗法 (PT) 对传统的X射线放射疗法 (XRT) 具有潜在的剂量优势,可以减少毒性并保护健康组织.
- 进行了健康技术评估,以评估PT在西班牙未经批准的癌症指示中的安全性和有效性.
研究的目的:
- 总结关于质子治疗 (PT) 在成人癌症患者中与X射线放射治疗 (XRT) 相比,对质子治疗 (PT) 的安全性和临床性能的发现.
- 为了评估在西班牙尚未批准的癌症指示的PT.
主要方法:
- 系统审查 (2012-2024) 坚持柯克伦标准,PRISMA指南和GRADE方法的初级研究.
- 用于资格标准的PICO-DT框架,专注于成人癌症患者和比较研究设计.
- 结果包括严重不良事件,死亡率,总生存率和无进展生存率;使用RoB 2.0和ROBINS-I.评估的偏差风险.
主要成果:
- 从6958个选记录中,包括16种瘤类型的76项研究 (5项RCT,71项观察性研究).
- 由于有限的RCT,方法方面的担忧和异质性,证据的确定性通常很低或非常低.
- 对于特定的适应症,如乳腺瘤转移,肺癌和门癌,PT可能相当于或优于XRT,但确定性有限.
结论:
- 质子疗法表现出可变的,癌症特异性的结果,并且不总是超过XRT.
- 某些迹象显示PT有前途,但仍然存在重大证据缺口.
- 高质量的比较研究和系统的临床数据收集对于进一步评估至关重要.
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