Effect of Induction Chemotherapy in Nasopharyngeal Carcinoma: An Updated Meta-Analysis.

Shan-Shan Yang,Chun-Yan Chen,Jian-Gui Guo,En-Ni Chen,Pu-Yun Ouyang,Fei Han,Fang-Yun Xie,Zhi-Qiao Liu,Jia-Ni Liu

doi:10.3389/fonc.2020.591205

Abstract

BackgroundPrevious meta-analysis had evaluated the effect of induction chemotherapy in nasopharyngeal carcinoma. But two trials with opposite findings were not included and the long-term result of another trial significantly differed from the preliminary report. This updated meta-analysis was thus warranted.MethodsLiterature search was conducted to identify randomized controlled trials focusing on the additional efficacy of induction chemotherapy in nasopharyngeal carcinoma. Trial-level pooled analysis of hazard ratio (HR) for progression free survival and overall survival and risk ratio (RR) for locoregional control rate and distant control rate were performed.ResultsTwelve trials were eligible. The addition of induction chemotherapy significantly prolonged both progression free survival (HR=0.68, 95% confidence interval [CI] 0.60–0.76, p<0.001) and overall survival (HR=0.67, 95% CI 0.54–0.80, p<0.001), with 5-year absolute benefit of 11.31% and 8.95%, respectively. Locoregional (RR=0.80, 95% CI 0.70–0.92, p=0.002) and distant control (RR=0.70, 95% CI 0.62–0.80) rates were significantly improved as well. The incidence of grade 3–4 adverse events during the concurrent chemoradiotherapy was higher in leukopenia (p=0.028), thrombocytopenia (p<0.001), and fatigue (p=0.038) in the induction chemotherapy group.ConclusionsThis meta-analysis supported that induction chemotherapy could benefit patients with nasopharyngeal carcinoma in progression free survival, overall survival, locoregional, and distant control rate.

Highlights

Nasopharyngeal carcinoma is an epithelial carcinoma arising from the nasopharyngeal mucosal lining
The addition of induction chemotherapy significantly prolonged both progression free survival (HR=0.68, 95% confidence interval [confidence intervals (CIs)] 0.60– 0.76, p
The incidence of grade 3–4 adverse events during the concurrent chemoradiotherapy was higher in leukopenia (p=0.028), thrombocytopenia (p

Summary

Introduction

Nasopharyngeal carcinoma is an epithelial carcinoma arising from the nasopharyngeal mucosal lining. The randomized trial was initiated in 1989 to test the added value of induction chemotherapy before radiotherapy [3], and improved disease free survival was observed but not overall survival. The long-term results [12, 13] of another two previous trials [7, 8] deserved great concern, especially the distinctive finding of induction chemotherapy of cisplatin and fluorouracil in 5-year overall survival [13]. Two trials with opposite findings were not included and the long-term result of another trial significantly differed from the preliminary report.

Methods

Results

Conclusion