Combined Chemoradiation Versus Radiation Therapy Alone in stage-II Nasopharyngeal Carcinoma: A Meta-analysis of the published literature

Publication date: Available online 3 April 2018
Source:Current Problems in Cancer
Author(s): Sufang Wang, Shan Li, Liangfang Shen
ObjectiveThe aim of this meta-analysis was to evaluate the efficacy and toxicity of adding chemotherapy to radiotherapy (RT) in the treatment of stage-II nasopharyngeal carcinoma (NPC).Materials and methodsWe searched Pubmed, Cochrane Library, Embase, China National Knowledge Internet, China Biology Medicine, VIP and Wanfang database for studies of the radiotherapy with or without chemotherapy in patients with stage-II NPC that were published in any language. Analyses were carried out using RevMan 5.3 software. The relative risk was used to evaluate the data, the I² test was used to compare heterogeneity, sensitivity analysis was used to evaluate the stability and reliability of the results.ResultsThere were 16 studies with 3,038 patients that were included in this analysis. Risk ratios (RR) of 1.04 (95% CI 1.01–1.06), 1.05 (95% CI 1.00–1.10), 1.05 (95% CI 1.02–1.07), and 1.00 (95% CI 0.97–1.03) were observed for overall survival (OS), progression-free survival (PFS), loco-regional failure-free survival (LRFS) and distant metastasis failure-free survival (DMFS). Subgroup analysis showed that compared with conventional RT alone, chemoradiation (CRT) could significantly improve OS (RR = 1.09 95% CI 1.03–1.15), PFS (RR = 1.20 95% CI 1.08–1.35), and LRFS (RR = 1.09, 95% CI 1.04–1.14), but did not significantly improve the rate of DMFS (RR = 1.03, 95% CI 0.94–1.12). However, compared with Intensity Modulated Radiation Therapy (IMRT) alone, CRT did not significantly improve the rate of OS (RR = 1.01 95% CI 0.99–1.03), PFS (RR = 0.99 95% CI 0.95–1.03), LRFS (RR = 1.02, 95% CI 0.99–1.05), and DMFS (RR = 0.99, 95% CI 0.96–1.01).ConclusionsCompared with conventional RT alone, CRT could significantly improve patients′ prognoses in terms of OS, PFS, and LRFS for stage-II NPC, but not DMFS, and CRT can provide greater benefits from concurrent chemotherapy than neoadjuvant chemotherapy. With IMRT, the stage-II NPC patients did not benefit from the addition of chemotherapy.



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