Abstract
To evaluate the efficacy and toxicity of induction chemotherapy followed by concurrent chemoradiotherapy (the treatment group) versus concurrent chemoradiotherapy with or without adjuvant chemotherapy (the control group) for 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. All randomized controlled trials were included for a meta-analysis performed with RevMan 5.1.0. The Grading of Recommendations Assessment, Development, and Evaluation system (GRADE) was used to rate the level of evidence. Eleven studies were included. Risk ratios of 0.99 (95%CI 0.72-1.36), 0.37 (95%CI 0.20-0.69), 1.08 (95%CI 0.84-1.38), 0.98 (95%CI 0.75-1.27) were observed for 3 years overall survival, 3 years progression-free survival, 2 years loco-regional failure-free survival and 2 years distant metastasis failure-free survival. There were no treatment-related deaths in either group in the 11 studies. Risk ratios of 1.90 (95%CI 1.24-2.92), 2.67 (95%CI 0.64-11.1), 1.04 (95%CI 0.79-1.37), 0.98 (95%CI 0.27-3.52) were found for grade 3-4 leukopenia, grade 3-4 thrombocytopenia, grade 3-4 mucous membrane, and grade 3-4 hepatic hematologic and gastrointestinal toxicity, the most significant toxicities for patients. Compared with the control group, induction chemotherapy followed by concurrent chemoradiotherapy was well tolerated but could not significantly improve prognosis in terms of overall survival, loco-regional failure-free survival or distant metastasis failure-free survival.
Highlights
Nasopharyngeal carcinoma (NPC) is endemic in southern China, south-east Asia and north Africa
This article is the first meta-analysis to evaluate the efficacy and toxicity of the therapy of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) versus CCRT with or without adjuvant chemotherapy (AC) for locoregionally advanced nasopharyngeal carcinoma
It had been proved that compared with the CCRT+/-AC group, IC followed by CCRT couldn’t significantly improve overall survival (OS), loco-regional failure-free survival (LFFS) and distant metastasis failure-free survival (DMFS) in this study
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% present 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). Concurrent chemoradiotherapy with or without adjuvant chemotherapy have become the standard therapy for advanced NPC
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