Department of Clinical Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea.
PLoS One. 2018 May 30;13(5):e0198015. doi: 10.1371/journal.pone.0198015. eCollection 2018.
Radiation pneumonitis is a common and serious complication of radiotherapy. Many published randomized controlled studies (RCTs) reveal a growing trend of using herbal medicines as adjuvant therapy to prevent radiation pneumonitis; however, their efficacy and safety remain unexplored.
The aim of this systematic review is to evaluate the efficacy and safety of herbal medicines as adjunctive therapy for the prevention of radiation pneumonitis in patients with lung cancer who undergo radiotherapy.
We searched the following 11 databases: three English medical databases [MEDLINE (PubMed), EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL)], five Korean medical databases (Korean Studies Information, Research information Service System, KoreaMed, DBPIA, National Digital Science Library), and three Chinese medical databases [the China National Knowledge Database (CNKI), Journal Integration Platform (VIP), and WanFang Database]. The primary outcome was the incidence of radiation pneumonitis. The risk of bias was assessed using the Cochrane risk-of-bias tool.
Twenty-two RCTs involving 1819 participants were included. The methodological quality was poor for most of the studies. Meta-analysis showed that herbal medicines combined with radiotherapy significantly reduced the incidence of radiation pneumonitis (n = 1819; RR 0.53, 95% CI 0.45-0.63, I2 = 8%) and the incidence of severe radiation pneumonitis (n = 903; RR 0.22, 95% CI 0.11-0.41, I2 = 0%). Combined therapy also improved the Karnofsky performance score (n = 420; WMD 4.62, 95% CI 1.05-8.18, I2 = 82%).
There is some encouraging evidence that oral administration of herbal medicines combined with radiotherapy may benefit patients with lung cancer by preventing or minimizing radiation pneumonitis. However, due to the poor methodological quality of the identified studies, definitive conclusion could not be drawn. To confirm the merits of this approach, further rigorously designed large scale trials are warranted.
放射性肺炎是放疗的常见且严重的并发症。许多已发表的随机对照研究（RCT）表明，使用草药作为辅助疗法预防放射性肺炎的趋势日益增长，但它们的疗效和安全性仍未得到探索。
本系统评价旨在评估草药作为肺癌患者放疗辅助治疗预防放射性肺炎的疗效和安全性。
我们检索了以下 11 个数据库：3 个英文医学数据库[MEDLINE（PubMed）、EMBASE、The Cochrane Central Register of Controlled Trials（CENTRAL）]、5 个韩国医学数据库[韩国研究信息、研究信息服务系统、韩国医学、DBPIA、国家数字科学图书馆]和 3 个中文医学数据库[中国国家知识数据库（CNKI）、期刊整合平台（VIP）和万方数据库]。主要结局指标是放射性肺炎的发生率。采用 Cochrane 偏倚风险工具评估偏倚风险。
纳入 22 项 RCT 共 1819 名参与者。大多数研究的方法学质量较差。Meta 分析显示，草药联合放疗显著降低了放射性肺炎的发生率（n = 1819；RR 0.53，95%CI 0.45-0.63，I2 = 8%）和重度放射性肺炎的发生率（n = 903；RR 0.22，95%CI 0.11-0.41，I2 = 0%）。联合治疗还改善了卡氏功能状态评分（n = 420；WMD 4.62，95%CI 1.05-8.18，I2 = 82%）。
有一些令人鼓舞的证据表明，口服草药联合放疗可能通过预防或最小化放射性肺炎使肺癌患者受益。然而，由于所确定研究的方法学质量较差，因此无法得出明确的结论。为了证实这种方法的优点，需要进一步进行严格设计的大规模试验。
