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Abstract
Objectives: This meta-analysis aimed to assess the clinical effectiveness and safety of Javanica oil emulsion injection (JOEI) combined with the radiotherapy (RT) for treating esophageal cancer (EC).Design: A literature search was conducted for collecting the randomized controlled trials (RCTs) on EC treated by JOEI in the Cochrane Library, PubMed, Embase, the Chinese Biomedical Literature Database (SinoMed), the China National Knowledge Infrastructure Database, the China Science and Technology Journal Database (VIP), and the Wanfang Database from inception to February 4, 2017. The quality of the RCTs was evaluated by the Cochrane risk of bias assessment tool, and objective remission rate, performance status, adverse drug reactions (ADRs), 1-year survival rate, and 2-year survival rate were analyzed by Review Manager 5.3 and Stata 13.0 software.Results: A total of 11 RCTs with 909 participants were involved in this meta-analysis. The results showed that in comparison with RT alone, the JOEI combined with RT was associated with the better effects on improving objective remission rate (relative risk [RR] = 1.33, 95% confidence interval [CI 1.17–1.52], Z = 4.44, p < 0.00001), performance status (RR = 1.52, 95% CI [1.25–1.85], Z = 4.24, p < 0.00001), 1-year survival rate (RR = 1.37, 95% CI [1.17–1.60], Z = 3.86, p < 0.0001), and 2-year survival rate (RR = 1.36, 95% CI [1.09–1.70], Z = 2.68, p = 0.007). The differences between the two groups in objective remission rate, performance status, 1-year survival rate, and 2-year survival rate were statistically significant. Besides, the JOEI combined with RT could reduce the incidence of ADRs. Specifically, the statistically significant difference was detected between these two groups about leukopenia (RR = 0.39, 95% CI [0.25–0.61], Z = 4.19, p < 0.0001), radiation esophagitis (RR = 0.68, 95% CI [0.50–0.93], Z = 2.42, p = 0.02), thrombocytopenia (RR = 0.92, 95% CI [0.12–0.66], Z = 2.95, p = 0.003), and hemoglobin reduction (RR = 0.53, 95% CI [0.35–0.79], Z = 3.14, p = 0.002); however, there was no statistically significant difference for the outcome of nausea and vomiting (RR = 0.61, 95% CI [0.36–1.03], Z = 1.85, p = 0.06) between two groups.Conclusion: This meta-analysis indicated that the combination of JOEI and RT was associated with the more beneficial treatment for patients with EC compared with only receiving RT. However, more well-designed and multicenter RCTs should be carried out to confirm this finding because of the limitations of enrolled 11 RCTs.
Highlights
Esophageal cancer (EC) is one of the common alimentary system cancers worldwide.[1,2] According to the relative report, its mortality may increase to 728,945 by 2035 and its incidence in men is 3–4 times higher than in females.[3,4] Due to dysphagia, the patients with EC usually suffer from hiccups, weight loss, and so on in early stages.[5,6] the pathogeny of EC is still unclear, several chemical elements such as nitrosamines, the lack of nutrition, and some biologic factors are deemed to dangers.[7,8] Currently, the treatment methods for EC were mainly radiotherapy (RT), surgery, chemotherapy, and so on.[9]
The results showed that in comparison with RT alone, the JOEI combined with RT was associated with the better effects on improving objective remission rate, performance status (RR = 1.52, 95% confidence interval (CI) [1.25–1.85], Z = 4.24, p < 0.00001), 1-year survival rate (RR = 1.37, 95% CI [1.17–1.60], Z = 3.86, p < 0.0001), and 2-year survival rate (RR = 1.36, 95% CI [1.09–1.70], Z = 2.68, p = 0.007)
The statistically significant difference was detected between these two groups about leukopenia (RR = 0.39, 95% CI [0.25–0.61], Z = 4.19, p < 0.0001), radiation esophagitis (RR = 0.68, 95% CI [0.50–0.93], Z = 2.42, p = 0.02), thrombocytopenia (RR = 0.92, 95% CI [0.12–0.66], Z = 2.95, p = 0.003), and hemoglobin reduction (RR = 0.53, 95% CI [0.35–0.79], Z = 3.14, p = 0.002); there was no statistically significant difference for the outcome of nausea and vomiting (RR = 0.61, 95% CI [0.36–1.03], Z = 1.85, p = 0.06) between two groups
Summary
Esophageal cancer (EC) is one of the common alimentary system cancers worldwide.[1,2] According to the relative report, its mortality may increase to 728,945 by 2035 and its incidence in men is 3–4 times higher than in females.[3,4] Due to dysphagia, the patients with EC usually suffer from hiccups, weight loss, and so on in early stages.[5,6] the pathogeny of EC is still unclear, several chemical elements such as nitrosamines, the lack of nutrition, and some biologic factors are deemed to dangers.[7,8] Currently, the treatment methods for EC were mainly radiotherapy (RT), surgery, chemotherapy, and so on.[9]. The integrated treatment of EC has been gradually recognized, and Traditional Chinese Medicine (TCM) could achieve the therapeutic effects of improving clinical benefits and reducing ADRs of RT.[12,13] EC belongs to dysphagia occlusion in TCM theory, which is considered as the occurrence of obstruction of esophagus caused by phlegm, blood stasis, and calculi.[14,15]
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