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
ARTICLE HIGHLIGHTS
Research background

The standard treatment for upper gastrointestinal cancers is surgical resection. However, many patients are diagnosed in middle-advanced stage or are elderly, and most of them have lost their best chance of surgery. These patients can only receive palliative treatments to relieve esophageal obstruction symptoms. Photodynamic therapy (PDT) can significantly improve the symptoms of patients with middle-advanced stage upper gastrointestinal carcinomas. PDT can also be used in combination with chemotherapy or radiation to improve efficacy and reduce side-effects.

Research motivation

The main aim of the present study was to clarify the effect of PDT alone or in combination with radiotherapy/chemotherapy for the treatment of middle-advanced stage upper gastrointestinal carcinomas.

Research objectives

This was the first comprehensive article on this topic to take into account all the available evidence. We quantified the effect of PDT in addition to radiotherapy/chemotherapy for middle-advanced stage upper gastrointestinal carcinomas.

Research methods

A meta-analysis was performed according to the guidelines of the PRISMA protocol. PubMed, Cochrane Library, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and China Science and Technology Journal Database databases were comprehensively searched for studies analyzing the effect of PDT alone or combined with radiotherapy/chemotherapy for middle-advanced stage upper gastrointestinal carcinomas. The risks of bias and quality of the individual studies were assessed using funnel plots and the Cochrane System Evaluation Manual Intervention. Both fixed and random effects models were used to estimate the risk ratios for dichotomous outcomes.

Research results

The statistical analysis involved 953 patients with middle-advanced stage upper gastrointestinal carcinomas. The results showed that the effective rate of PDT was better than that of radiotherapy or Nd:YAG laser for the treatment of middle-advanced stage upper gastrointestinal carcinomas. Furthermore, PDT combined with chemotherapy gave significantly better efficacy and higher one-year survival rates than PDT or chemotherapy alone.

Research conclusions

PDT may be suitable for single or combined treatment of middle-advanced stage upper gastrointestinal carcinomas, especially for patients in old age, with severe diseases, severe complications, or who are unwilling to undergo surgery.

Research perspectives

Further research would be essential to understand the effect of PDT alone or combined with radiotherapy/chemotherapy in the treatment of middle-advanced stage upper gastrointestinal carcinomas. A multicenter, double-blind, randomized controlled trial could provide a better answer.