Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers

Background: The objective was to locate, appraise and summarise evidence fr om scientific studies on intestinal obstruction due to advanced gynaecologi cal and gastrointestinal cancers, in order to assess the efficacy of cortic osteroids. Materials and methods. Data sources: A comprehensive list of studies was pr ovided by an extensive search of electronic databases, relevant journals, b ibliographic databases, conference proceedings, reference lists, the grey l iterature, personal contact and the world wide web. Data synthesis: Two res earchers extracted the data independently. A qualitative analysis was perfo rmed of the dichotomous data of resolution of obstruction and death at one month. Both fixed and random effect models were used. Number needed to trea t (with corticosteroids to resolve one episode of bowel obstruction) was de rived from the odds ratio. Kaplan-Meier survival curves from individual pat ient data were also analysed. Studies of lower methodological quality were assessed in a qualitative manner. Results: There is a trend towards resolution of bowel obstruction using cor ticosteroids, but this result does not achieve statistical significance. Th ere is no statistically significant difference in mortality at one month, n or in the Kaplan-Meier survival curves. Number needed to treat is 6, though with wide confidence intervals (3-infinity). The results are robust to fix ed and random effects models and to 'best' and 'worst case' scenarios on th e data from missing patients. The morbidity associated with corticosteroids appears to be very low. Conclusions: The role of corticosteroids needs further elucidation. More pa tients need to be recruited in order to obtain more precise results. Furthe r trials should include quality of life measures as primary outcomes as wel l as most effective type of corticosteroid, dose or dosing regime, route of administration and morbidity.