The efficacy of locoregional radiotherapy plus chemotherapy vs. chemotherapy alone in metastatic nasopharyngeal carcinoma: a meta-analysis.

Abstract

The role of locoregional radiotherapy (LRT) of the nasopharynx and neck in patients with metastatic nasopharyngeal carcinoma (M-NPC) remains unclear. The present meta-analysis aimed to compare the efficacy of chemotherapy (CT) plus LRT with CT alone in M-NPC patients. Eligible manuscripts were searched in the following electronic databases: Cochrane Library, Embase, and PubMed. The hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS), and the risk ratio (RR) of the objective response rate (ORR) and disease control rate (DCR) were pooled and expressed with the 95% confidence intervals (CIs). The analysis was conducted using Review Manager and Stata software. In total 15 retrospective studies and 1 randomized controlled trial were identified comparing 3,402 M-NPC patients of whom 1,387 received CT alone and 2,015 were treated with CT plus LRT. The adjusted HR of OS for CT plus LRT compared with CT alone was 0.45 (95% CI: 0.40-0.52), while the pooled HR of PFS was 0.37 (95% CI: 0.29-0.49). The pooled RR of ORR and DCR for CT plus LRT compared with CT alone was 0.60 (95% CI: 0.46-0.79) and 0.77 (95% CI: 0.71-0.85), respectively. Heterogeneity or publication bias in the studies was not found to have altered the conclusion. For patients with M-NPC, CT + LRT is superior to CT alone providing the higher OS, PFS, ORR, and DCR compared with CT alone. CT combined with LRT should be recommended as a more suitable choice for M-NPC patients.