Abstract
Ethnopharmacological relevance: Esophageal cancer is one of the most common human cancers, and its incidence is highly endemic in China. The combination of Chinese herbal injections (CHIs) and radiotherapy should be informed by the best available evidence.Aim of the study: To update and expand on previous work in order to compare and rank the efficacy and safety of CHIs in combination with radiotherapy to treat esophageal cancer.Materials and Methods: We searched several electronic databases to identify randomized controlled trials (RCTs) regarding CHIs to treat esophageal cancer from their inception to March 15, 2017. In a network meta-analysis (NMA), the bias of the included trials was assessed by two individuals independently in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Outcomes such as the clinical effectiveness rate, performance status, adverse reactions (ADRs), and survival rate were evaluated. We performed a random-effects NMA to obtain estimates of efficacy and safety outcomes, and we present these estimates as odds ratios (ORs) and corresponding 95% confidence intervals (CIs) calculated via Stata 13.1 and WinBUGS 1.4 software. Furthermore, the surface under cumulative the ranking curve (SUCRA) was used to rank the efficacy and safety of different CHIs in relation to each outcome.Results: Of 685 identified trials, 55 were eligible for inclusion in the study. These 55 trials included 12 CHIs and 4,114 participants. The cluster analysis results suggested that Compound kushen injection therapy is the optimal CHI treatment for patients with esophageal cancer in terms of improving the clinical effectiveness rate and performance status. Huachansu and Kangai injection are superior in improving 1-year and 2-year survival rates. Lentinan injection may be considered a favorable choice for reliving ADRs, and Compound kushen injection may provide treatment benefits by reducing both gastrointestinal reaction and radiation esophagitis.Conclusions: The current clinical evidence indicated that Compound kushen injection combined with radiotherapy is the most preferable and beneficial option for patients with esophageal cancer in terms of efficacy and safety. However, the results of our study should be interpreted with caution given the limitations of the sample size and the methodological quality of the included trials.
Highlights
Esophageal cancer, the eighth most common cancer worldwide, is extremely aggressive and has a low survival rate (Pennathur et al, 2013; Zacherl, 2014)
After duplicates and irrelevant articles were removed, 282 studies remained, and through further inspection, a total of 55 randomized controlled trials (RCTs) involving 12 Chinese herbal injections (CHIs) met our selection criteria. These RCTs were included in the current Network meta-analysis (NMA), and their details are provided in File S1
The number of studies included for different CHIs was as follows: Aidi injection (15 trials), compound kushen injection (11 trials), Javanica oil emulsion injection (10 trials), Kangai injection (7 trials), Huachansu injection (4 trials), Elemene injection (2 trials), Astragalus polysaccharide injection (1 trial), Astragalus injection (1 trial), Lentinan injection (1 trial), Shenmai injection (1 trial), Disodium cantharidinate and vitamin B6 injection (1 trial), and Shenqifuzheng injection (1 trial)
Summary
Esophageal cancer, the eighth most common cancer worldwide, is extremely aggressive and has a low survival rate (Pennathur et al, 2013; Zacherl, 2014). An increasing number of patients are diagnosed with esophageal cancer at the advanced stages, and some cases can benefit from radiotherapy to improve overall and progression-free survival as well as locoregional control (Shridhar et al, 2013; Nguyen et al, 2014). Studies have demonstrated that radiotherapy is often accompanied by serious adverse reaction (ADRs), further impairing the health-related performance status of cancer patients (Beukema et al, 2015). To address this relevant issue, traditional Chinese Medicine (TCM) as an adjuvant cancer treatment has exhibited increased efficacy and reduced side effects (Xu et al, 2015; Cai et al, 2017). In recent decades, inducing cancer apoptosis with TCM has become increasingly popular in the field of oncology (Zhang et al, 2016)
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