Objective The objective of this study is to find individualized, evidence-based treatment for a patientwith extensive small cell lung cancer, malignant pleural effusion, and liver metastasis.Methods According to the PICO (patient intervention comparison outcome) principle, evidence was collected and critically assessed. The patient’s preference was also taken into consideration in the decision making process. Results We included 10 randomized controlled trials, 13 systematic reviews and meta-analyses, and three clinical guidelines. The evidence indicated that chemotherapeutic treatment prolongs survival in patients with extensive small cell lung cancer and AiDi injections could relieve adverse effects caused by chemotherapy or radiotherapy. Cisplatin and etoposide are considered major standard cytotoxic drugs for small cell lung cancer. We drained the pleural cavity and infused Bleomycin into the pleural cavity. We also used an EP regimen of chemotherapy after the patient’s condition had improved. This patient survived longer than the average survival time for small cell lung cancer patients and has enjoyed a higher quality of life. Conclusion Chemotherapy is the main medical treatment for patients with extensive small cell lung cancer, backed up by symptomatic treatment and supportive care. Prophylactic cranial irradiation decreases brain metastases incidence and improves survival in complete response small cell lung cancer patients.
Objective To evaluate the effectiveness and safety of postoperative intraperitoneal hyperthermic perfusion chemotherapy (IHPC) for advanced gastric cancer, so as to provide references for clinical practice and study. Methods The following databases including The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang were searched on computer, and other searches were also performed to collect all relevant randomized controlled trials (RCTs) on postoperative IHPC versus intravenous chemotherapy alone (IC) for advanced gastric cancer. The quality of the included studies was assessed according to Cochrane Handbook 5.1 for Systematic Review, and Meta-analysis was conducted by using RevMan 5.1 software. Results A total of 18 RCTs involving 2299 patients were included. The results of meta-analyses showed that: a) Efficacy evaluation: There were significant differences between the IHPC group and the IC group in 1-, 2-, 3-, and 5-year survival rate, 3- and 5-year recurrence rate, and 3- and 5-year distant metastasis rate; the OR value and 95%CI were 1.88 (1.49, 2.39), 2.45 (1.64, 3.67), 2.29 (1.92, 2.73), 2.17 (1.70, 2.76), 0.39 (0.29, 0.52), 0.54 (0.40, 0.72), 0.55 (0.38, 0.78), 0.58 (0.42, 0.81), respectively; b) Safety evaluation: There were significant differences between the IHPC group and the IC group in the incidence of abdominal pain, abdominal distension, nausea and vomiting; the OR value and 95%CI were 2.20 (1.58, 3.07), 7.00 (2.67, 18.36), 0.65 (0.45, 0.95), respectively. But there were no significant differences between the IHPC group and the IC group in the incidence of alopecia, ileus, bone marrow inhibition, and hepatic lesion. Conclusion Compared with IC, postoperative IHPC+IC can improve survival rate and reduce the recurrence and distant metastasis rate; additionally, it is safe and feasible, so it is recommended that the detailed condition of patients should be taken into consideration when the postoperative IHPC+IC therapy is applied to clinic.
Objective To evaluate the clinical efficacy and safety of hyperthermia combined with radiotherapy and chemotherapy (HRCT) for non-small cell lung cancer (NSCLC), so as to provide references for further clinical practice and research. Methods The databases such as The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched on computer from the date of their establishment to May 1st of 2011, and other sources as supplied were also retrieved to collect all the relevant randomized controlled trials (RCTs) on comparing HRCT with non-HRCT. The quality of the included trials was assessed according to the Cochrane Handbook 5.1 for Systematic Review and the features of this study as well. Meta-analyses were conducted by using RevMan 5.1 software. Results A total of eight RCTs involving 546 patients were included. The results of meta-analyses showed that: a) Total effective rate: The total effective rate of HRCT was higher than other non-HRCT therapies, and there were significant differences in HRCT compared with radio-chemotherapy, hyperthermia plus chemotherapy, and pure chemotherapy, the OR and 95%CI were 2.05 (1.18, 3.56), 3.41 (1.12, 10.38), and 6.11 (1.20, 31.16), respectively; and b) Safety evaluation: The incidence rates of radiation pneumonitis, radiation esophagitis and granulocytopenia were all lower in the HRCT group than that in the radio-chemotherapy group, but the significant differences were only found in the incidence rate of granulocytopenia (OR=0.34 (0.19, 0.59). Conclusion Compared with other therapies, HRCT tends to improve the clinical efficacy and safety for NSCLC, but this result needs to be proved by more clinical trials. HRCT is superior to the routine radio-chemotherapy in both efficacy and safety, but the relevant evidence for proving its long-term efficacy and safety is still required.
Objective To evaluate the clinical effectiveness and safety of transcatheter arterial chemoembolization (TACE) combined with argon-helium cryotherapy system (AHCS) for primary hepatic carcinomas (PHC), and to provide references for clinical practice and research. Methods Such databases as The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were searched, and other sources like the relavant references were also retrieved to collect the randomized controlled trials (RCTs) about TACE combiend with AHCS for PHC published by May 1st, 2012. After literature screening, data extraction and quality evaluation performed by two reviewers independently according to the inclusion criteria, the meta-analysis was conducted using RevMan 5.1 software. Results A total of 16 RCTs involving 1 467 patients were included. The results of meta-analysis showed: a) The TACE+AHCS group was superior to the TACE alone group in total effective rate, complete necrosis rate, 0.5-, 1-, 1.5-, 2- and 2.5-year survival rates, AFP, CD4 and Th/Ts cells, and there were significant differences (Plt;0.05); and b) The TACE+AHCS group was superior to the AHCS alone group in 0.5-, 1.5-, 2- and 2.5-year survival rates, AFP and Th/Ts cells, and there were significant differences (Plt;0.05). Conclusion Compared with the TACE or AHCS alone, TACE combined with AHCS can improve long-term survival rate and short-term curative effect, and improve PHC patients’ immunity. However, its long-term curative effect and safety still needs to be further verified by more large sample and high quality RCTs.
Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with thermotherapy for primary hepatic carcinoma (PHC), and to provide references for clinical practice and research. Methods The following databases as The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched electronically, and the other sources as supplying, such as tracing related references, were also retrieved. Besides, some unknown information was also obtained by communicating with other authors. All randomized controlled trials (RCTs) on TACE combined with thermotherapy versus TACE alone were collected. The literature was screened according to inclusive criteria, data were extracted and the quality of included studies was assessed, and then meta-analysis was conducted using RevMan 5.1 software. Results A total of 17 RCTs with 907 patients were included. Meta-analysis showed that compared with TACE alone, TACE combined with thermotherapy had a significant difference in 1-year survival rate (HR=2.40, 95%CI 1.65 to 3.48, Plt;0.000 01), 2-year survival rate (HR=3.28, 95%CI 1.87 to 5.76, Plt;0.000 1), total effective rate (RR=1.59, 95%CI 1.42 to 1.79, Plt;0.000 1) and improvement rate of life quality (RR=1.79, 95%CI 1.42 to 2.25, Plt;0.000 1). The incidences of myelosuppression and alimentary canal reactions were lower in TACE combined with thermotherapy group than those in TACE alone group, but statistically significance was only found in myelosuppression (RR=0.79, 95%CI 0.69 to 0.92, P=0.001). Conclusion Compared with TACE alone, TACE combined with thermotherapy can improve long-term survival rate and short-term curative effect, ameliorate the quality of life, and tend to reduce the incidence rate of side effects. But its long-term curative effect and more comprehensive safety still needs to be further verified by more large sample and high quality RCTs.
Objective To evaluate the effectiveness and safety of radiosensitizer metronidazole amino acidum natrium (CMNa) for esophagus carcinoma. Methods Databases including The Cochrane library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched from their establishment dates to Feb. 1st 2012 for randomized controlled trials (RCTs) of CMMa for esophagus carcinoma. Two reviewers independently screened literature and assessed the quality of the included studies and extracted data. Meta-analysis waw conducted using RevMan 5.1 software. Results A total of 17 RCTs involving 1 475 patients met the inclusion criteria. Results of meta-analyses showed that: a) As for short-term response, the total effectiveness of the experimental group given CMNa plus radiotherapy was higher than the control group given radiotherapy alone (OR=3.51, 95%CI 2.44 to 5.07, Plt;0.000 01). b) Significant differences were found in the quality of life, and one and two year survival rates (OR=2.90, 95%CI 1.91 to 4.39, Plt;0.000 01; OR=1.95, 95%CI 1.21 to 3.15, P=0.006). In accordance with the P-value of 0.05, there was a significant difference in three-year survival rate (OR=2.28, 95%CI 1.16 to 4.49, P=0.02). c) As for safety, no significant differences were found in radiation pneumonitis, radiation esophagitis, myelosuppression and mucous membrane reactions. Conclusion CMNa plus radiotherapy has beneficial effects in the treatment of esophagus carcinoma and improves 1, 2 and 3-year survival rates, but more RCTs on the quality of life and safety evaluation are needed.
Objective To evaluate the psychological trauma incurred by the hospitalization survivor of Zhouqu district after the Zhouqu debris flow so as to provide relevant information for psychological and medical interventions. Methods The psychological state of 67 hospitalized survivors of the disaster and other 47 inpatients with similar complaints but not coming from the disaster area was investigated through a mental health self-assessment questionnaire, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and PTSD-SS scale. Results The post-disaster survivors had different levels of psychological problems and post-traumatic stress disorder, and there were significant differences compared to the control group (Plt;0.01, Plt;0.01). The SDS score and the SAS score of the survivor were 48.44+15.648 and 52.92+11.672, respectively, which were all much higher than those of the control group (Plt;0.01, Plt;0.05). Conclusion The debris flow disaster bring serious psychological trauma to the victims. It is necessary to pertinently carry out post-disaster psychological relief including psychological intervention and regulation for the hospitalized survivors, so as to alleviate and reduce their psychological suffering.