Abstract
To determine if it is preferable to add induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) for treatment of locally advanced nasopharyngeal carcinoma (LANPC). We searched various biomedical databases for randomized trials (RCTs) comparing IC plus CCRT versus (vs) CCRT alone in LANPC. The primary outcome was overall survival (OS). Secondary outcomes include progression-free survival (PFS), locoregional progression-free survival (LRPFS) and distant metastasis-free survival (DMFS). We assessed the quality of the summarized evidence using the GRADE approach. We performed the meta-analysis with a random effects model. We used meta-regression to determine if there is an effect modification on the association between IC and the efficacy outcome by pre-specified factors (age, gender, T4 stage of disease, N2 or N3 stage of disease, region where the trial was conducted (Asia vs non-Asia), use of docetaxel, cisplatin and fluorouracil and use of intensity modulated radiotherapy). We found seven eligible randomized trials with no significant methodological bias including 1894 patients. The addition of induction chemotherapy improved OS (hazard ratio (HR) 0.819, 95% confidence interval (CI) 0.674-0.994, P-value (P) = 0.043, I-squared (I2) = 0%), PFS (HR 0.706, 95% CI 0.603-0.826, P < 0.0001, I2= 0%), LRFPS (HR 0.722, 95% CI 0.562-0.929, P = 0.011, I2 = 0%) and DMFS (HR 0.669, 95% CI 0.544-0.824, P <0.0001, I2 = 0%). The GRADE quality of summarized evidence was high. Meta-regression did not demonstrate any effect modification on the association between IC and the four outcomes of interest by the prespecified factors. IC plus CCRT significantly improved progression-free and overall survival and reduced both locoregional and distant disease recurrence for LANPC. Future research should evaluate the role of adding immunotherapy in LANPC treated with CCRT.
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