| OBJECTIVE: Now most literature research results show that the effectiveness of zoledronic acid plus radiotherapy for treating bone metastasis have curative effect, but also a part of the study revealed that no difference of zoledronic acid combined with radiotherapy in pain control efficiency, reduce the incidence of tumor of bone metastasis, improve the life quality of the patients. In view of the nonconsistentence of clinical study report on effectiveness and safety of zoledronic acid plus radiotherapy for treating bone metastasis, therefore, the purpose of this study is to detailedly and comprehensively analysis all the randomized controlled trials or the quasi-randomized controlled trials of zoledronic acid plus radiotherapy versus simple radiotherapy for treating bone metastasis, to clear the clinical curative effect and security of zoledronic acid plus radiotherapy for treating bone metastasis, and to provide the evidence based medicine for clinical practice.METHODS:Randomized controlled trials (RCTs) were identified by Cochrane Library (Issue 10,2012), PubMed (1966～2012.10), EMBASE (1974-2012.10), China National Knowledge Infrastructure / CNKI (1994-2012.10), China Biology Medicine/ CBM (1978～ 2012.10), VIP(1989-2012.10), WanFang (1997～2012.10). As well as by multiple pathways to obtain more relevant research literature. Randomized controlled trials or quasi randomized controlled trials, which were collected at home and abroad, were provided by the two researchers independently. the meta analysis of the results of the included studies was performed using RevMan 5.0 software.RESULTS:A total of 28 randomized controlled trials (were all chinese literatures, involving 2021 cases) whish had been published were included in this meta-analysis,3 studies mention showed specific random grouping method,2 studies used specific blind method,28 RCT studies were described not lost to follow-up. The specific randomized method, the specific allocation concealment method and specific blinding method of the rest of the literature research were also not clear. Meta-analysis showed that:Compared with radiotherapy alone, zoledronic acid plus radiotherapy could improve in effective rate of pain relive at the end of treatment (OR=3.08, 95%CI:2.30-4.12, p<0.00001), effective rate of pain relive over two weeks after treatment (OR=3.39,95%CI:2.52-4.56, p<0.00001), total effective rate of improved quality of life (OR=2.74, 95%CI:1.66-4.52, p<0.00001), improvement of daily living activity(OR=2.96,95%CI:2.16-4.05, p<0.00001) and decrease the probability of new bone metastasis(OR=0.21,95%CI:0.10-0.45, p<0.00001). The adverse reactions ratio of zoledronic acid plus radiotherapy, such as fever and hypocalcaemia, was higher.CONCLUSION: The actual available and limited supporting evidence indicated that: compared with radiotherapy alone, zoledronic acid plus radiotherapy for bone metastases was more effective. The combine treatment is safe and effective, especially in pain relive, improvement of daily living activity and quality of life, and in decreasing new bone metastasis, and improve the bone metastatic lesion repair rate. In addition, in the aspect of safety, although zoledronic acid combined with radiotherapy groups in fever, hypocalcemia incidence is high, but symptomatic can be treated and do not affect the continuation of treatment. Therefore, zoledronic acid plus radiotherapy is recommended as an effective treatment options for local treatment for malignant tumor bone metastasis in patients with a systemic therapy and is worth to apply in clinic and further study. |
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