| ObjectiveTo systematically review the effectiveness and safety of intracavitary perfusion chemotherapy with endostar plus platinum for malignant serous effusion.MethodsSuch databases as CNKI, CBM, WanFang, Vip, EMBASE, PUBMED and WEB of SCIENCE were searched for related literatures of intracavitary perfusion chemotherapy with endostar plus platinum for malignant serous effusion from inception to December 8,2014.Then a meta-analysis was performed using revman 5.3 software.ResultsA total of 25 RCTs involving 1523 patients were included,749 cases in endostar plus platinum group,774 in platinum alone group. The results were as follows:1.The results of the summary analyssis(1) Intracavitary perfusion chemotherapy with endostar plus platinum versus platinum alone for malignant serous effusion, the pool response rate of 25 RCTs and improvement rate in quality of life of 18 RCTs was 1.63 (76% vs.48%, 95%CI:1.50-1.78,P< 0.00001) and 1.57 (69% vs.44%,95%CI:1.42-1.74,P< 0.00001)(2) 1 RCT including 42 cases of patients with lung cancer complicated with malignant pleural effusion showed that 1 year and 2 years survival rate was 61.9% vs.42.86%,33.33% vs.4.76%(P<0.05), respectively.2 RCTs reported the patients overall survival, one study included 42 cases of patients with NSCLC, the other study included 22 cases of NSCLC,12 cases of breast cancer and 6 cases of the othe tumor patients, the OS was 17.2 vs.11.4 months,18.8 vs.13.7 months (P< 0.05), respectively. (3) A meat-analysis showed that the pool nausea and vomiting, leukopenia and renal impairment incidence was 1.01 (35% vs.34%, 95%CI:0.87-1.18, P=0.88),1 (38% vs.38%,95%CI:0.87-1.15, P=0.99) and 0.86 (18% vs.20%,95%CI:0.43-1.74, P=0.68), respectively.2.Effusion efficiency subgroup analysis results(1) Different malignant serous effusion type subgroup 19 studies of malignant pleural effusion had a good homogeneity, RR was 1.64 (77% vs.47%, 95%CI:1.49-1.81, P< 0.00001); the response rate of 1 malignant peritoneal effusion study was 77% vs.41%(P=0.04) in experimental group and control group.(2) Different tumor type subgroup 13 studies of lung cancer had a good homogeneity, RR was 1.69 (78% vs.46%,95%CI:1.49-1.9, P< 0.00001)(3) Different endostar dose subgroup The subgroups had a good homogeneity, the pool 5 studies of endostar 30mg every time was 1.70 (79%vs.47%,95%CI:1.40-2.06, P< 0.00001); 6 studies of 45mg every time was 1.76 (79% vs.45%,95%CI:1.45-2.14, P<0.00001); 8 studies of 60mg every time was 1.62 (74% vs.46%,95%CI:1.40-1.88, P< 0.00001); 2 studies of being equal or above 90mg every time was 1.51 (66% vs.43%,95%CI:1.15-1.99, P=003)(4) Different treament interval time subgroup The subgroups had a good homogeneity, the pool 3 studies of interval of 3 days was 1.51 (75% vs.49%,95% CI:1.19-1.91, P=0.0007); 19 studies of interval of 7 days was 1.67 (76% vs.46%,95%CI:1.51-1.85, P<0.00001). The response rate of 1 studies of interval of 21 days was 72%vs.52%(P<0.05) in experimental group and control group.(5) Different treament duration subgroup The subgroups had a good homogeneity, the pool 6 studies of treament duration for less than or equal to 2 weeks was 1.58 (74% vs.47%,95%CI:1.33-1.88, P< 0.00001); 13 studies of treament duration for more than 2 weeks (most studies for 4 weeks) was 1.61 (79% vs.49%,95%CI:1.44-1.81, P< 0.00001)(6) Different platinum type subgroup 22 studies of combining with cisplatin had a good homogeneity, RR was 1.65 (75% vs.46%,95%CI:1.51-1.81, P< 0.00001); 2 studies of combining with nedaplatin had a heterogeneity, RR was 1.52 (83% vs.55%,95%CI:0.82-2.85, P=0.19) using random effects model; The response rate of 1 studies of combining with carboplatin was 83% vs.57% (P< 0.05) in experimental group and control group.Conclusion1. Compared with platinum alone, intracavitary perfusion chemotherapy with endostar plus platinum can significantly improve effusion treatment response rate, patients’quality of life improves and that the incidence of adverse reactions does not increace obviously. It prolongs patients the median survival time with limited literature reportes.2. Endostar plus platinum compared with platinum alone, used for intracavitary perfusion chemotherapy for malignant pleural effusion or lung cancer patients with malignant pleural effusion, the former shows better effect.3. In clinical practice, endostar dose is recommended 45mg every time, per week, treatment duration 2-4 weeks combined with platinum optimally for intracavitary perfusion. |
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