5 november 2022: Bron: Front. Pharmacol., 29 August 2022 Sec. Ethnopharmacology
Maligne ascites (MA) (vocht in de buikholte) is een veel voorkomende complicatie bij patiënten met terminale kanker, die de levenskwaliteit en de kwaliteit van leven van kankerpatiënten ernstig beïnvloedt. Uit een meta-analyse werd gezien dat wanneer hyperthermische intraperitoneale chemotherapie (HIPEC) gecombineerd wordt met Traditionele Chinese geneeskunde (TCM) er een statistisch significante effectiviteit bereikt wordt. Vooral bij de Maligne ascites (MA) en dit bij de kankerpatiënten hun kwaliteit van leven sterk verbetert.
Eerdere studies hebben aangetoond dat een TCM-behandeling het ontstaan van Maligne ascites (MA) effectief kan afremmen, de toxiciteit van chemotherapie kan verlichten, de klinische symptomen van patiënten kan verlichten, de immuunfunctie en kwaliteit van leven van patiënten kan verbeteren en de overlevingsperiode kan verlengen. Een TCM-behandeling heeft weinig bijwerkingen en een hoge veiligheid. (Kong, 2021).
In met name China wordt een TCM-behandeling aanbevolen te gebruiken in combinatie met een hyperthermische intraperitoneale chemotherapie (HIPEC) bij patiënten met Maligne ascites (MA), waardoor de werkzaamheid van de medicijnen kan verbeteren en de bijwerkingen van de chemo kan verminderen. En wordt dus ook veel gebruikt bij de behandeling van Maligne ascites (MA). (Wang, 2020).
Uit het abstract van de studie:
In deze reviewstudie - meta-analyse zijn 19 onderzoeken met in totaal 1.504 patiënten opgenomen. De resultaten toonden aan dat in vergelijking met het eenmalig gebruik van een HIPEC, TCM in combinatie met HIPEC de klinische werkzaamheid (RR = 1.51, 95% CI [1,40, 1.63], p < 0.00001) en karnofsky performance status (KPS) score (MD = 8,16, 95% BI [6,46, 9,85], p < 0,00001), en het vochtvolume vermindert (MD = -156,98, 95% BI [-213,71, -100,25], p < 0,00001).
De resultaten toonden aan dat de klinische werkzaamheid van TCM in combinatie met HIPEC (608/762) significant beter was dan die van de enkele HIPEC zonder TCM (392/742) (RR = 1.51, 95% CI [1.40, 1.63], p < 0.00001, Figure 3).
Het volledige studierapport is gratis in te zien of te downloaden. Klik daarvoor op de titel van het abstract. Zie verder ook in referenties.
The efficacy of traditional chinese medicine combined with hyperthermic intraperitoneal chemotherapy for malignant ascites: A systematic review and meta-analysis
Zhixian Lin
Jiangfeng Chen
Yunxia Liu- 1Department of Oncology, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, China
- 2Department of Integrated Traditional Chinese & Western Medicine Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
Objective: Malignant ascites (MA) is a common complication of terminal cancer, which seriously affects the life quality and prognosis of patients. Both hyperthermic intraperitoneal chemotherapy (HIPEC) and traditional Chinese medicine (TCM) preparations have achieved significant efficacy in the treatment of MA. The treatment strategy of TCM combined with HIPEC has been gradually promoted and applied in China. The purpose of this systematic review and meta-analysis was to assess the efficacy of TCM combined with HIPEC in the treatment of MA.
Methods: Randomized controlled trials (RCTs) of TCM combined with HIPEC for MA were searched from seven electronic databases. Two researchers used the Cochrane Collaboration’s tool to assess the risk of bias. Excel 2019 was used to establish a database for information extraction, RevMan 5.4 software was used to analyze the included test data, and STATA v16.0 was used to conduct Egger’s test to further detect publication bias.
Results: A total of 19 studies involving 1,504 patients were included in this meta-analysis. The results showed that compared with the single use of HIPEC, TCM combined with HIPEC could significantly improve the clinical efficacy (RR = 1.51, 95% CI [1.40, 1.63], p < 0.00001) and karnofsky performance status (KPS) score (MD = 8.16, 95% CI [6.46, 9.85], p < 0.00001), reduce the ascites volume (MD = −156.98, 95% CI [−213.71, −100.25], p < 0.00001). However, there was no statistical significance in reducing abdominal circumference between TCM combined with HIPEC and HIPEC alone (MD = −1.8, 95% CI [−4.57, −0.97], p = 0.2).
Conclusion: This study found that TCM combined with HIPEC had a beneficial therapeutic effect on MA. However, more standard, double-blind, multicenter RCTs are needed to further confirm the efficacy of TCM combined with HIPEC in the treatment of MA.
Systematic Review Registration: https://www.crd.york.ac.uk/, identifier CRD42022319993.
Characteristics of included studies
A total of 19 RCTs were included in this study, with a total of 1,504 patients, including 762 patients in the trial group and 742 patients in the control group. All studies were conducted in China between 2010 and 2021.
Seven of the studies (Wen et al., 2015; Dai et al., 2016; Chen and Hua, 2017; Gao and Zhang, 2017; Zhang et al., 2018; Shao et al., 2019; Rui and Peng, 2021) included only ovarian cancer patients, one study (Zhang and Li, 2018) only included gastric cancer patients, nine studies (Cui and Wu, 2010; Wu et al., 2016; Pan et al., 2017; Zhang et al., 2017; Jiang and Hu, 2019; Cai and Zhu, 2020; Li et al., 2020; Mei et al., 2020; Li, 2021) included multiple tumor types, two studies (Li, 2020; Zhang et al., 2020) did not report the tumor type. The control group in five studies (Wu et al., 2016; Pan et al., 2017; Zhang et al., 2018; Shao et al., 2019; Rui and Peng, 2021) were treated with HIPEC combined with intravenous chemotherapy, and the trial group were treated with TCM on this basis, and the control group in remaining 14 studies (Cui and Wu, 2010; Wen et al., 2015; Dai et al., 2016; Chen and Hua, 2017; Gao and Zhang, 2017; Zhang et al., 2017; Zhang and Li, 2018; Jiang and Hu, 2019; Cai and Zhu, 2020; Li, 2020; Li et al., 2020; Mei et al., 2020; Zhang et al., 2020; Li, 2021) only received HIPEC, and the trial group added TCM on this basis. One study (Dai et al., 2016) used paclitaxel single agent for HIPEC, one study (Zhang and Li, 2018) used 5-fluorouracil and cisplatin for HIPEC, and the remaining 17 studies (Cui and Wu, 2010; Wen et al., 2015; Wu et al., 2016; Chen and Hua, 2017; Gao and Zhang, 2017; Pan et al., 2017; Zhang et al., 2017; Zhang et al., 2018; Jiang and Hu, 2019; Shao et al., 2019; Cai and Zhu, 2020; Li, 2020; Li et al., 2020; Mei et al., 2020; Zhang et al., 2020; Li, 2021; Rui and Peng, 2021) used cisplatin single agent for HIPEC. The trial group in 15 studies (Cui and Wu, 2010; Dai et al., 2016; Wu et al., 2016; Chen and Hua, 2017; Gao and Zhang, 2017; Pan et al., 2017; Zhang et al., 2018; Jiang and Hu, 2019; Shao et al., 2019; Cai and Zhu, 2020; Li, 2020; Mei et al., 2020; Zhang et al., 2020; Li, 2021; Rui and Peng, 2021) was treated with oral administration of TCM, the trial group in four studies (Wen et al., 2015; Zhang et al., 2017; Zhang and Li, 2018; Li et al., 2020) were treated with external application of TCM. Table 1 summarized the patient characteristics of the included studies, including age, gender, sample size, interventions, the course of treatment, outcomes, etc.
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Data availability statement
The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.
Author contributions
ZL and JC initiated this study and participated in its design. ZL, JC, and YL performed study selection, data extraction, and data analysis. The manuscript was drafted by ZL and revised by ZL and JC. All authors contributed to the article and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fphar.2022.938472/full#supplementary-material
Abbreviations
CNKI, China national knowledge infrastructure; CI, confidence interval; CR, complete remission; HIPEC, hyperthermic intraperitoneal chemotherapy; I2, I-square; KPS, karnofsky performance status; MA, malignant ascites; MD, mean difference; PD, progression disease; PR, partial remission; RCTs, randomized controlled trials; RR, risk ratio; SD, stable disease; TCM, traditional Chinese medicine; VIP, Chinese scientific journal database; WM, western medicine.
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Keywords: hyperthermic intraperitoneal chemotherapy, malignant ascites, traditional Chinese medicine, efficacy, meta-analysis
Citation: Lin Z, Chen J and Liu Y (2022) The efficacy of traditional chinese medicine combined with hyperthermic intraperitoneal chemotherapy for malignant ascites: A systematic review and meta-analysis. Front. Pharmacol. 13:938472. doi: 10.3389/fphar.2022.938472
Received: 07 May 2022; Accepted: 25 July 2022;
Published: 29 August 2022.
Edited by:
Alessandra Durazzo, Council for Agricultural Research and Economics, ItalyReviewed by:
Sohan Lal Solanki, Tata Memorial Hospital, IndiaZhu Guanghui, China Academy of Traditional Chinese Medicine, China
Jerry Lorren Dominic, Jackson Memorial Hospital, United States
Copyright © 2022 Lin, Chen and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhixian Lin, 841675972@qq.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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