A Systematic Review Of Thermotics Therapy Combined With Radiotherapy And Chemotherapy In The Treatment Of Advanced Non-small Cell Lung Cancer

Background and objective:In most patients with lung cancer is found already in advanced stages, surgical methods can not be treated. Thermal therapy is the treatment method of choice. However, the safety and efficacy of thermal therapy in advanced non-small cell lung cancer(NSCLC) is currently no comprehensive systematic review. This study was designed to evaluate the efficacy and safety of thermal therapy combined with radiotherapy and chemotherapy of advanced NSCLC, and to provide a reference for the clinical practice and in depth study.Methods: Relevant randomized controlled trials(RCTs) and controlled trials(CTs) were obtained from The Cochrane Library, Pub Med, EMBASE, CBM, CNKI, VIP and Wanfang databases. RCTs and CTs of Argon helium knife(AHF) or Radiofrequency ablation(RFA) combined with radiotherapy and/or chemotherapy for advanced NSCLC before November, 2014, were included. The quality of studies was assessed, data were extracted and cross-checked by researchers independently. The meta-analysis was conducted by using the Cochrane Collaboration Rev Man 5.2 software.Result: Thirty-two studies involving 2 687 patients were included. Meta-analysis showed that there was no significant difference in efficiency and 1,2,3-year survival rates between patients treated with AHF alone and those with AHF plus chemotherapy(all P > 0.05). Compared to chemotherapy alone, AHF with chemotherapy improved short-term effect and clinical benefit rate(OR=3.02, 95% CI: 1.91~4.77, P< 0.00001;OR=3.18, 95% CI: 1.72~5.89, P=0.0002), and also improved 1,2-year overall survival rates of NSCLC patients(OR=1.99, 95% CI: 1.23~3.20, P=0.005; OR=27.89, 95% CI: 1.57~494.62, P=0.02). Compared to AHF treatment alone, AHF with radiotherapy improved 1,2-year overall survival rate(OR=1.77,95% CI: 1.03~3.06, P=0.04). Compared with chemotherapy plus radiotherapy, AHF combined with chemotherapy and radiotherapy improved survival quality(OR=3.34, 95% CI: 1.53~7.29, P=0.002). compared to chemotherapy group, RFA plus chemotherapy group can improve Advanced NSCLC patients`6month, 1,2,3-year survival rate(OR=5.57,95%CI:2.90~10.70)(OR=2.01,95%CI:1.41~2.86)(OR=2.48,95%CI:1.51~4.07)(OR=2.29,95% CI:1.24~4.22),were higher obviously and had the statistical significant(P<0.05), and also put no additions on complications and adverse reactions(P>0.05).In addition, compared to chemotherapy and radiotherapy treatment, the RFA plus chemotherapy and radiotherapy could improve overall rate survival rate of Advanced NSCLC patients in a 1-year period(OR=2.09 95% CI:1.11–3.94).Similarly, the RFA plus chemotherapy and radiotherapy could improve the KPS(OR=3.25,95%CI:1.60~6.61), were higher obviously and had the statistical significant(P<0.05).Conclusion: Compared with chemotherapy, RFA combined with chemotherapy have a distinct advantage in improving the survival rate of patients with advanced NSCLC, and does not increase the complications and adverse reactions; AHF combined with chemotherapy can improve the efficacy and safety better. Compared with chemotherapy, RFA combined with chemotherapy improved survival and quality of life of patients, and the security is better; AHF combined radiotherapy and chemotherapy can improve the quality of life of patients. Compared with pure AHF, AHF combined with radiotherapy can improve its effectiveness.