Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2018; 6(13): 650-658
Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.650
Photodynamic therapy for middle-advanced stage upper gastrointestinal carcinomas: A systematic review and meta-analysis
Bo Chen, Li Xiong, Wei-Dong Chen, Xiao-Hua Zhao, Jun He, Yan-Wen Zheng, Fan-Hua Kong, Xi Liu, Zi-Jian Zhang, Xiong-Ying Miao
Bo Chen, Li Xiong, Wei-Dong Chen, Xiao-Hua Zhao, Jun He, Yan-Wen Zheng, Fan-Hua Kong, Xi Liu, Zi-Jian Zhang, Xiong-Ying Miao, Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: Miao XY and Xiong L designed the research; Chen B, Chen WD and Zhao XH contribute equally to this work; He J and Zheng YW contributed to analytic tools; Kong FH and Liu X analyzed the data; Chen B and Zhang ZJ wrote the paper; Chen B and Xiong L participated in revisions of the manuscript.
Supported by the National Natural Science Foundation of China, No. 81372628, No. 81773293, and No.31660266; the Natural Science Foundation of Hunan Province, No. 12JJ5048; and the Science and Technology Plan Fund of Hunan Province, P.R. China, No. 2018JJ3758, No. 2017WK2063, No. 2017DK2011, No. 2015GK3117, and No. 2014WK2016.
PRISMA 2009 Checklist statement: The manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiong-Ying Miao, MD, Professor, Department of General Surgery, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha 410011, Hunan Province, China. miaoxiongying3016@csu.edu.cn
Telephone: +86-731-88836045 Fax: +86-731-84895199
Received: July 19, 2018
Peer-review started: July 19, 2018
First decision: August 25, 2018
Revised: September 13, 2018
Accepted: October 11, 2018
Article in press: October 11, 2018
Published online: November 6, 2018
Processing time: 110 Days and 2.4 Hours
Abstract
AIM

To determine the therapeutic effect of photodynamic therapy (PDT) for middle-advanced stage upper gastrointestinal carcinomas.

METHODS

We searched PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database from inception to April 2018 for randomized controlled studies. These studies compared PDT with other palliative therapies (radiotherapy, chemotherapy, or Nd:YAG laser) and compared PDT, radiotherapy, or chemotherapy alone with PDT combined with chemotherapy/radiotherapy. In our meta-analysis, both fixed and random effects models were used to estimate the risk ratio (RR) for dichotomous outcomes (the response rate and one-year survival rate).

RESULTS

Ten random controlled clinical studies with 953 patients were included in the analysis. The effective rate for PDT was better than that of radiotherapy or Nd:YAG laser for the treatment of middle-advanced upper gastrointestinal carcinomas [RR = 1.36; 95% confidence interval (CI): 1.13-1.65; P = 0.001]. In addition, PDT combined with chemotherapy had significantly better efficacy and a higher one-year survival rate than PDT or chemotherapy alone (significant remission rate, RR = 1.62; 95%CI: 1.34-1.97; P < 0.00001; one-year survival rate, RR = 1.81; 95%CI: 1.13-2.89; P = 0.01).

CONCLUSION

PDT is a useful method for the treatment of middle-advanced stage upper gastrointestinal carcinomas. PDT combined with chemotherapy or radiotherapy can enhance its efficacy and prolong survival time.

Keywords: Photodynamic therapy; Radiotherapy; Chemotherapy; Upper gastrointestinal tract; Nd:YAG laser; Gastrointestinal neoplasm; Gastrointestinal diseases; Meta-analysis

Core tip: Photodynamic therapy (PDT) is minimally invasive compared with chemotherapy and radiotherapy for the treatment of cancers. Limited data exist regarding the efficacy of PDT alone or combined with radiotherapy and chemotherapy for the treatment of middle-advanced stage upper gastrointestinal carcinomas. Therefore, we performed a systematic review and meta-analysis of ten available randomized controlled clinical trials that addressed the efficacy of PDT alone or combined with radiotherapy and chemotherapy in patients with middle-advanced stage upper gastrointestinal carcinomas. Our analysis showed that PDT may be suitable for single or combined treatment of middle-advanced stage upper gastrointestinal carcinomas, especially for elderly patients, those with severe diseases, those with severe complications, and those unwilling to undergo surgery.