Comparative efficacy and safety of Chinese medicine injections as an adjunctive therapy for cervical cancer in Chinese patients: a network meta-analysis

Abstract

Context

Chinese medicine injections (CMIs) are widely used as adjuvant therapy for cervical cancer in China. However, the effectiveness of different types of CMIs remains uncertain.

Objective

To assess the effectiveness and safety of CMIs when used in conjunction with radiotherapy (RT) or concurrent chemoradiotherapy (CCRT), particularly in combination with cisplatin (DDP), docetaxel plus cisplatin (DP), and paclitaxel plus cisplatin (TP).

Materials and methods

Randomized controlled trials (RCTs) were searched in databases including CNKI, WanFang, VIP, SinoMed, PubMed, Cochrane Library, Embase, and Web of Science from inception to September 2023. We calculated the risk ratio with a 95% confidence interval and the surface under the cumulative ranking area curve (SUCRA) for the clinical efficacy rate (CER), the efficacy rate by Karnofsky Performance Status (KPS), and the rates of leukopenia reduction (LRR) and gastrointestinal reactions (GRR).

Results

Forty-seven RCTs were included, including nine CMI types: Aidi, Fufangkushen, Huangqi, Kangai (KA), Kanglaite (KLT), Renshenduotang, Shenqifuzheng (SQFZ), Shenmai (SM), and Yadanzi. KLT and KA were likely optimal choices with radiotherapy for CER and KPS, respectively. KA and KLT were optimal choices with RT + DDP for CER and GRR, respectively. KLT was the likely optimal choice with RT + DP for CER and KA for both KPS and GRR. SM and SQFZ were the likely optimal choices with RT + TP for CER and LRR, respectively.

Conclusions

The optimal recommendation depends on whether CMIs are used with radiotherapy or concurrent chemoradiotherapy. More high-quality RCTs are needed to confirm further and update the existing evidence.

Keywords:

• Chinese medicine injections (CMIs)
• Radiotherapy (RT)
• concurrent chemoradiotherapy (CCRT)
• efficacy
• safety
• network meta-analysis
• randomized controlled trials (RCTs)

Acknowledgements

The authors thank the Home for Researchers editorial team (www.home-for-researchers.com) for a language editing service.

Authors’ contributions

Sun SG and Song HY designed the study. Ma F, Wang Q, Zhang D, Wang ZH, and Xie H conducted literature searches, data extraction, and methodological quality evaluation and wrote the manuscript. Sun SG performed the statistical analysis and created the tables and pictures. Liu XH and Zhang HX helped to revise the manuscript. All authors approved the final version of the manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

All data generated or analyzed during this study are included in this published article, further inquiries can be made with the corresponding author(s).

Additional information

Funding

This work was supported by [High Level Talent Cultivation Project of Traditional Chinese Medicine of Shandong Province] under Grant [2023 No. 143 Letter, Health Commission of Shandong Province]; [Project of National Traditional Chinese Medicine Characteristic Technology Inheritance Talent] under Grant [2023 No. 96 Letter, National Administration of Traditional Chinese Medicine]; [Project of National Famous and Old Traditional Chinese Medicine Expert ZHANG Hongxing Inheritance Studio] under Grant [2022 No. 75 Letter, National Administration of Traditional Chinese Medicine]; [Project of National Old Traditional Chinese Medicine Expert LIU Xianghong Inheritance] under Grant [2022 No. 76 Letter, National Administration of Traditional Chinese Medicine]; [Natural Science Foundation of Shandong Province] under Grant [ZR2019MH063]; [Key Research and Development Project of Shandong Province] under Grant [2019GNC21307]; and [Science and Technology Development Project of Traditional Chinese Medicine of Shandong Province] under Grant [2019-0208, 2019-0215, 2019-0914, 2017-114].