Evidence of elemene injection combined radiotherapy in lung cancer treatment among patients with brain metastases: A systematic review and meta-analysis

BACKGROUND: This review evaluates the effectiveness and safety of elemene injection combined radiotherapy in the treatment of lung cancer with brain metastases. METHODS: A systematic literature research was conducted from EMBASE, Cochrane Library, PubMed, Chinese biomedical database, Chinese scientific journal database, China knowledge resource integrated database, and WanFang Database from established to July 2016 without language restriction. The Cochrane Collaboration tool was used to evaluate the risk of bias. All statistical analyses were conducted with STATA (version 14.0) and RevMan (version 5.3). RESULTS: Eleven randomized controlled trials (765 patients) were included for determining the effectiveness and safety of elemene combined with radiotherapy in the treatment of lung cancer with brain metastases. Objective response rate (ORR) [odds ratio (OR) = 2.89, 95% confidence interval (95% CI) 2.04–4.08, P < .00001] and symptoms (OR = 4.06, 95% CI 2.00–8.25, P = .0001) improved more in the elemene-based combination treatment group than in the radiotherapy-alone control group. The Karnofsky Performance Status (KPS) score was used to measure patients’ improvement rate. The patients who were treated with elemene-based combination with radiotherapy were higher than those patients who were treated with radiotherapy alone (OR = 3.51, 95% CI 2.20–5.61, P < .00001]. The incidence of bone marrow suppression (OR = 0.27, 95% CI 0.11–0.68, P = .006) and leukopenia (OR = 0.23, 95% CI 0.12–0.46, P < .00001) decreased in the elemene-based combination treatment group by radiotherapy significantly. CONCLUSIONS: The elemene injection combined radiotherapy in the treatment of lung cancer with brain metastases appears to improve the treatment response rate and alleviated symptoms. The combined treatment has showed positive impact to reduce adverse reactions and improve quality of life.