Systematic review and network meta-analysis comparing Chinese herbal injections with chemotherapy for treating patients with esophageal cancer

OBJECTIVE: This study compared Chinese herbal injections (CHIs) plus chemotherapy with chemotherapy alone in terms of clinical efficacy and safety for treating patients with esophageal cancer (EC). METHODS: Randomized controlled trials (RCTs) of CHIs combined with chemotherapy for treating EC published in English and Chinese databases were identified. The main outcomes were clinical efficacy, performance status, and adverse reactions. Random-effects models were fitted to calculate the odds ratios and 95% confidence intervals for all pair-wise comparisons. RESULTS: In total, 29 RCTs of eight CHIs were included in this study. The results of cluster analysis demonstrated that Compound Kushen injection plus chemotherapy was the optimal choice for improving the clinical efficacy rate. Shenfu injection was associated with a relatively high performance status. Compound Kushen injection and Shenfu injection were inferior to other CHIs in terms of preventing leukopenia and gastrointestinal side effects. CONCLUSIONS: The combination of Compound Kushen injection with chemotherapy could improve efficacy and reduce adverse drug reactions versus chemotherapy alone in patients with EC.