Chemoradiation combined with regional hyperthermia for advanced oesophageal cancer: a systematic review and meta-analysis.

WHAT IS KNOWN AND OBJECTIVE: Hyperthermia is an effective treatment modality that augments the anticancer effects of radiotherapy and chemotherapy. Hyperthermia-chemo-radiotherapy (HCRT) is a combination therapy that can strengthen anticancer effects through a synergistic interaction between heat, chemotherapy and radiation. Here, we carried out a systematic review and meta-analysis to evaluate the clinical efficacy and safety of chemoradiation combined with regional hyperthermia (HCRT) for oesophageal carcinoma. METHODS: We conducted computer searches of foreign databases, including Cochrane Library, PubMed, EMBASE, Web of Science and Chinese databases, including CBM, CNKI and WanFang; we also retrieved other sources as supplement. All relevant randomized controlled trials (RCTs) were collected to compare HCRT and other therapies, including chemotherapy combined with radiotherapy (CRT) and radiotherapy alone (RT). After literature screening, data extraction and quality evaluation performed by appropriate criteria, the meta-analyses were conducted using RevMan 5.1 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). RESULTS AND DISCUSSION: Nineteen RCTs were included, comprising 1519 patients. Meta-analysis showed that the 1-, 3-, 5- and 7-year survival, complete response and total effective rates of the HCRT group were higher than those of the CRT group; the rates of gastrointestinal reaction, leucocytopenia and radiation oesophagitis in the HCRT group were lower than those of the CRT group, indicating significant differences (P < 0·05). The 1-, 2-, 3- and 5-year survival, complete response and total effective rates of the HCRT group were higher than those of the RT group, the recurrence and distant metastasis rates of the HCRT group were lower than those of the RT group, and there were significant differences in all of the indicators (P < 0·05). WHAT IS NEW AND CONCLUSIONS: This is the first systematic review and meta-analysis to evaluate HCRT for oesophageal carcinoma. Compared with CRT or RT, HCRT can improve long-term and short-term curative effects; it is also safe and feasible. Additional high-quality and large sample size RCTs will be necessary to further demonstrate the long-term survival benefits and comprehensive safety profile of HCRT.

Cisplatin plus etoposide versus other platin-based regimens for patients with extensive small-cell lung cancer: a systematic review and meta-analysis of randomised, controlled trials.

AIM: To determine whether the cisplatin plus etoposide (EP) combination was more efficacious and less toxic than other platinum-based regimens for patients with extensive-stage small-cell lung cancer. METHODS: We performed an extensive literature search (from their inception to July 2010). Two reviewers independently assessed search results and methodological quality of included studies. Pooled hazard ratios (HRs) and relative risks (RRs) were calculated according to a random-effects model. RESULTS: Twelve randomised, controlled trials involving seven different platinum-based chemotherapy regimens were included into this meta-analysis. The meta-analysis showed that compared with EP regimen, irinotecan plus cisplatin (IP) might decrease the risk of death (HR = 0.87, 95% confidence interval (CI) 0.78-0.97, P = 0.01) (five trials), unlike the sensitivity analysis (HR = 0.91, 95% CI 0.81-1.02, P = 0.12), progression-free survival (HR = 0.95, 95% CI 0.86-1.05, P = 0.28) and overall response rate (RR 1.08, 95% CI 0.93-1.24) that were not superior for IP. IP regimen produced more non-haematological toxicities and less haematological toxicities. One trial found that etoposide + cisplatin + epirubicin + cyclophosphamide and cisplatin + etoposide + ifosfamide regimen might prolong the overall survival respectively. Etoposide + cisplatin + epirubicin + cyclophosphamide regimen also might improve progression-free survival but with high rate of haematological toxicities. None of the other trials included in the study demonstrated a significant improvement in survival. CONCLUSIONS: There is no strong evidence that any clinical advantage for extensive small-cell lung carcinoma patients requiring chemotherapy when comparing EP with other platin-based regimens, with exception of IP that might prolong overall survival. The decision to prescribe which chemotherapy should take into consideration both cost and treatment preference.

Geographic pathology on the precursors of stomach cancer.

The classification of dysplasias of the gastric mucosa used in our institute includes adenomatous dysplasia, regenerative dysplasia, and cryptal dysplasia. We compared the incidence of gastric dysplasia in three regions of China which have quite different geographical environments: the loess plateau of Wuwei area in the Gansu Province, the island of the Yangtze River in the Jiangsu Province of southern China, and the coastal area of the Liaoning Province in northern China. The mortality rate of stomach cancer in these areas is more than 50 per 100,000. We found a total of 323 cases of gastric dysplasia in these three areas. Regenerative dysplasia is the most common precancerous lesion of the stomach and was found in 40% of the cases from the three high-risk areas of gastric cancer. The background lesions consist of gastric erosions, severe gastritis, gastric ulcers, and intestinal metaplasia, which indicate that some factors causing damage to gastric mucosa are very important in the histogenesis of stomach cancer. The gastric dysplasia sites involved are different in the three geographical regions studied. On the island of the Yangtze River, cardiac dysplasia and intestinal metaplasia are common (75%), and cancer of the cardia is also common. In the other two geographical areas, antral dysplasia predominates (85 to 91%). The finding of different sites of gastric dysplasia in different geographical environments may be very important in our search for etiological factors of gastric cancer and may allow for beneficial intervention in the prevention of this disease.