Induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) and CCRT alone are both standard treatment regimens for managing locally advanced nasopharyngeal carcinoma (NPC). However, the results of comparisons between them in clinical trials vary. Therefore, we designed this meta-analysis to illustrate their advantages and disadvantages in patients with locally advanced NPC.
We thoroughly searched the PubMed, EMBASE, and Cochrane Library databases and then merged the effect indicators of hazard ratios (HRs) and risk ratios (RRs) using RevMan 5.1.
Seven randomized controlled trials totaling 2,319 patients were included in our research. The synthesized results showed that IC plus CCRT improved overall survival (HR=0.74, 95% CI: 0.62-0.88, P< 0.001), progression-free survival (HR=0.66, 95% CI: 0.57-0.77, P< 0.001), distant metastasis-free survival (HR=0.65, 95% CI: 0.43-0.81, P<0.001) and locoregional recurrence-free survival (HR=0.68 95%, CI: 0.54-0.86, P=0.001) versus CCRT alone. It also increased the risk of anemia, thrombocytopenia, and neutropenia during CCRT. However, the incidence of leukopenia and mucositis was similar in IC and IC plus CCRT. Furthermore, the subgroup analysis showed better survival outcomes with IC plus CCRT than with CCRT alone in the triweekly cisplatin subgroup (all P<0.01), whereas IC plus CCRT could only improve progression-free survival and locoregional recurrence-free survival in the weekly cisplatin subgroup (HR= 0.71, P=0.02; and HR=0.66, P=0.03, respectively).
IC plus CCRT improved survival outcomes in patients with locally advanced NPC versus CCRT. For the weekly cisplatin regimen subgroup, it did not improve remote control or progression-free survival versus CCRT alone, warranting further clarification.
The protocol of our study has been registered with PROSPERO, and the number is CRD42018087074.
The authors.
People's Government of Yunnan Province (no grant number is applicable).
All authors have declared no conflicts of interest.