Abstract
The main objective of the present study was to evaluate the efficacy and toxicity of concurrent chemoradiotherapy followed by adjuvant chemotherapy compared with concurrent chemoradiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma. The search strategy included Pubmed, Embase, the Cochrane Library, China National Knowledge Internet Web, Chinese Biomedical Database and Wanfang Database. We also searched reference lists of articles and the volumes of abstracts of scientific meetings. Randomized controlled trials (RCTs) that compared concurrent chemoradiotherapy followed by adjuvant chemotherapy with concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma were included. Meta-analysis was performed with RevMan 5.1.0. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to rate the level of evidence. Five studies were included. Risk ratios of 1.02 (95%CI 0.89-1.15), 0.93 (95%CI 0.72-1.21), 1.07 (95%CI 0.87-1.32), 0.95 (95%CI 0.80-1.13) were observed for 3 years overall survival, 5 years failure-free survival, 5 years loco- regional failure-free survival and 5 years distant metastasis failure-free survival. There were no treatment-related deaths in both groups of five studies. Hematologic and gastrointestinal toxicity were the most significant for patients during adjuvant chemotherapy. The level of evidence was low. Compared with concurrent chemoradiotherapy alone, concurrent chemotherapy followed by adjuvant chemotherapy did not improve prognosis. More toxicity was found during adjuvant chemotherapy.
Highlights
Nasopharyngeal carcinoma (NPC) is endemic in southern China, south-east Asia and north Africa
The main objective of the present study was to evaluate the efficacy and toxicity of concurrent chemoradiotherapy followed by adjuvant chemotherapy compared with concurrent chemoradiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma
Randomized controlled trials (RCTs) that compared concurrent chemoradiotherapy followed by adjuvant chemotherapy with concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma were included
Summary
Nasopharyngeal carcinoma (NPC) is endemic in southern China, south-east Asia and north Africa. The incidence in southern China is reported to be about 80 cases per 100,000, which brings great threat to the local people (Chan et al, 2002). Because the early clinical symptoms are not obvious, at least 60% of patients with NPC present with locally advanced disease, while about 5–8% pres¬ent with distant metastases at diagnosis (Fong et al, 1996; Heng et al, 1999). Radiation therapy is the main treatment for nasopharyngeal carcinoma. For advanced NPC, the Intergroup 0099 study showed that concurrent chemoradiotherapy (CCRT) with adjuvant chemotherapy (AC) provided a 31% increase in 3 year overall survival (Al-Sarraf et al, 1998) and, since 1998 this regimen had become the standard therapy for advanced nasopharyngeal carcinoma
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