Comparing the Effectiveness of Endoscopic Surgeries With Intensity-Modulated Radiotherapy for Recurrent rT3 and rT4 Nasopharyngeal Carcinoma: A Meta-Analysis.

Zhouying Peng,Kelei Gao,Weihong Jiang,Ruohao Fan,Yaxuan Wang,Hua Zhang,Yumin Wang

doi:10.3389/fonc.2021.703954

Abstract

BackgroundThis meta-analysis aimed to compare the efficacy of intensity-modulated radiotherapy (IMRT) and endoscopic surgery (ES) for high T-stage recurrent nasopharyngeal carcinoma (NPC).MethodsRelevant studies were retrieved in six databases from 02/28,2011 to 02/28,2021. The 2-year, 3-year, 5-year overall survival (OS) rates and 2-year disease-free survival (DFS) rates were calculated to compare the survival outcomes of the two treatments of IMRT and ES. Combined odds ratios (ORs) and 95% confidence interval (C Is) were measured as effect size on the association between high T-stage and 5-year OS rates.ResultsA total of 23 publications involving 2,578 patients with recurrent NPC were included in this study. Of these, 1611 patients with recurrent rT3-4 NPC were treated with ES and IMRT in 358 and 1,253 patients, respectively. The combined 2-year OS and 5-year OS rates for the two treatments were summarized separately, and the 2-year OS and 5-year OS rate for ES were 64% and 52%, respectively. The 2-year OS and 5-year OS rate for IMRT were 65% and 31%, respectively. The combined 2-year DFS rates of IMRT and ES were 60% and 50%, respectively. Combined ORs and 95% confidence intervals for 5-year survival suggest that ES may improve survival in recurrent NPC with rT3-4. In terms of complications, ES in the treatment of high T-stage recurrent NPC is potentially associated with fewer complications.ConclusionsThe results of our study suggest that ES for rT3-4 may be a better treatment than IMRT, but the conclusion still needs to be sought by designing more studies.

Highlights

Nasopharyngeal carcinoma (NPC) is a type of squamous head and neck cancer with variable geographic distribution, with the highest incidence in Southeast Asia
The survival and prognosis studies of endoscopic surgery (ES) and intensity-modulated radiotherapy (IMRT) for recurrent NPC have been reported in the literatures [5, 9, 10], but there is no literature comparing the efficacy of the two treatment modalities for locally advanced recurrent rT3-4 NPC
Twelve articles investigated endoscopic surgery for recurrent NPC covered a total of 852 patients, including 494 patients with stage recurrent rT1-2 NPC and 358 patients with stage rT3-4

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is a type of squamous head and neck cancer with variable geographic distribution, with the highest incidence in Southeast Asia. The 5-year survival rate for salvage nasopharyngectomy for resectable recurrent NPC is 40% to 60%, compared with 8% to 36% for patients with local recurrence treated with recourse radiotherapy and often with severe complications, such as multiple cranial nerve palsies, osteonecrosis, and internal carotid artery dissection [7]. The survival and prognosis studies of ES and IMRT for recurrent NPC have been reported in the literatures [5, 9, 10], but there is no literature comparing the efficacy of the two treatment modalities for locally advanced recurrent rT3-4 NPC This meta-analysis aimed to compare the efficacy of intensity-modulated radiotherapy (IMRT) and endoscopic surgery (ES) for high T-stage recurrent nasopharyngeal carcinoma (NPC)

Methods

Results

Discussion

Conclusion