Chinese herbal medicine in pediatric oncology: Effects on survival and toxicity - a meta-analysis.
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BACKGROUND: Pediatric oncology treatment often involves aggressive therapies causing significant side effects, including immune suppression, gastrointestinal disturbances, and hematological toxicities. Although Chinese Herbal Medicine (CHM) has shown promise in mitigating adverse effects and enhancing overall treatment outcomes, there is a need for comprehensive evidence assessments conducted with scientific rigor to validate its role within evidence-based medicine. OBJECTIVE: This systematic review and meta-analysis evaluates the efficacy of CHM as an adjunct to conventional cancer therapies in pediatric oncology, focusing on reducing treatment-related toxicities, improving immune function and remission rates. METHODS: A comprehensive search of English and Chinese databases was conducted to identify randomized controlled trials (RCTs) involving pediatric oncology patients treated with CHM alongside conventional therapies. After study selection, data on clinical outcomes were extracted such as remission rates, immune parameters, and incidence of adverse effects. Odds ratios (OR) and mean differences (MD) were pooled with subgroup analysis. This review was conducted following PRISMA 2020 guidelines. The pre-study protocol was registered with PROSPERO (CRD42023422125). RESULTS: A total of 49 RCTs involving 29 different herbal prescriptions and 136 substances were meta-analyzed. CHM significantly improved complete remission rates (OR: 1.82; 95% CI: [1.44-2.29]) and partial remission rates (OR: 2.92; 95% CI: [2.23-3.83]). CHM also enhanced immune parameters, including increases in CD4+ counts (MD: 7.30; 95% CI: [5.70-8.91]) and CD4+/CD8+ ratio (MD: 0.27; 95% CI: [0.18-0.35]). Hematological stability was supported through improved platelet (MD: 17.02; 95% CI: [7.60-26.44]) and neutrophil counts (MD: 0.65; 95% CI: [0.17-1.13]). CHM significantly reduced infection rates (OR: 0.37; 95% CI: [0.26-0.52]), nausea/vomiting (OR: 0.43; 95% CI: [0.30-0.62]), and ECG abnormalities (OR: 0.39; 95% CI: [0.16-0.93]). These findings suggest CHM contributes to both enhanced efficacy and reduced toxicity during pediatric cancer treatment. CONCLUSION: CHM shows promise as a complementary therapy in pediatric oncology, particularly in reducing the toxicities of conventional cancer treatments and supporting immune function. However, further large-scale, multicenter trials are needed to establish standardized protocols for its integration of CHM into pediatric cancer care.