Brucea javanica oil emulsion as an adjunct to chemoradiotherapy in cervical cancer: a systematic review and meta-analysis of adverse effects reduction and immune enhancement.

BACKGROUND: Brucea javanica oil emulsion (BJOE) has been proposed as an adjuvant therapy to mitigate adverse reactions in cervical cancer patients receiving radiotherapy/chemotherapy, yet its efficacy remains understudied. This meta-analysis aimed to systematically evaluate the clinical benefits and safety of BJOE in this population. METHODS: We searched PubMed, Embase, Cochrane Library, and six other databases for Randomized controlled trials (RCTs) up to February 2025. Primary outcomes included adverse reactions (rectal symptoms, nausea/vomiting, leukopenia, radiation cystitis) and immune function markers (CD3+, CD4+, CD8+). Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using RevMan 5.4 and Stata 13.0. RESULTS: Five RCTs (N = 372 patients) were included. BJOE supplementation significantly reduced the incidence of rectal symptoms (RR = 0.56, 95%CI: 0.45-0.68), nausea/vomiting (RR = 0.60, 95%CI: 0.43-0.85), leukopenia (RR = 0.52, 95%CI: 0.34-0.77), and radiation cystitis (RR = 0.46, 95%CI: 0.33-0.63). Immune function improved markedly (CD3+: MD = 4.42, 95%CI: 3.76-5.08; CD4+: MD = 2.50, 95%CI: 1.88-3.13; CD8+: MD = 3.14, 95%CI: 1.84-4.43). CONCLUSION: As an adjunctive rather than a direct antitumor agent, BJOE effectively reduces treatment-related adverse effects and enhances immune responses in patients with cervical cancer undergoing chemoradiotherapy, supporting its clinical utility. However, the current evidence grades predominantly fall into the low or very low categories, further large-scale trials are warranted to validate these findings.