The clinical effect of β-elemene-assisted radiochemotherapy in the treatment of esophageal cancer: a systematic review and meta-analysis

Chenxi Li, Yiying Zeng, Nana Zhang, Bingtao Zhai, Chao Zhang, Yao Zhu, Zhaowu Zeng, Tian Xie


Background: The involvement of traditional Chinese medicine β-elemene in the treatment of esophageal cancer with radiochemotherapy could make a difference on clinical outcomes.This meta-analysis was conducted to analyze the safety and efficacy of helpful role with β-elemene in assisting the treatment of radiochemotherapy.
Methods: Literature retrieval was performed in Chinese Journal Full-text Database, Wanfang Database, China Biological Science Literature Database, VIP Knowledge Resource System, Web of Science, PubMed and assisted in other searches. Randomized controlled trials (RCTs) to evaluate effects of β-elemene-assisted radiochemotherapy for EC were identified. Data extracted from documents that meet the inclusion criteria we defined. Review Manager 5.3 (RevMan5.3) was used for data analysis.
Results: A total of 14 studies were included with 1,034 individuals. The results of Meta-analysis indicated that the esophageal cancer (EC) patients received β-elemene adjuvant therapy were superior to the control group in improving the response rate [odds radio (OR) =0.14, 95% confidence intervals (CIs): 0.09–0.19, P<0.00001] and the quality of life (OR =2.62, 95% CI: 1.52–4.53, P=0.0005). Compared with the control group that only received chemoradiotherapy, the EC patients received β-elemene adjuvant therapy had obvious advantages in the indicators of 2-year survival rate (OR =1.78, 95% CI: 1.18–2.66, P=0.006), 1-year local control rate (OR =1.95, 95% CI: 1.17–3.27, P=0.01) and 2-year local control rate (OR =1.98, 95% CI: 1.23–3.17, P=0.005) respectively. More importantly, the EC patients received β-elemene adjuvant therapy yielded better outcomes compared to the control group about myelosuppression rate (OR =0.73, 95% CI: 0.55–0.97, P=0.03) .But in decreasing the incidence of alimentary canal reactions (OR =0.87, 95% CI: 0.64–1.17, P=0.34), radiation pneumonitis (OR =0.01, 95% CI: –0.07 to 0.09, P=0.81) and radiation esophagitis (OR =–0.01, 95% CI: –0.09 to 0.07, P=0.79), there was no remarkable statistical difference between two groups.
Conclusions: The β-elemene-assisted radiochemotherapy in treatment of EC to improve short term effect, 2-year survival rate, 1-year local control rate and 2-year local control rate. The treatment group has showed positive impact on improve the quality of life and reduce the myelosuppression rate.