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The evaluation of adding induction chemotherapy to concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: a meta-analysis

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Abstract

Purpose

We performed a meta-analysis to compare the efficacy and safety of induction chemotherapy (IC) followed by cisplatin-based concurrent chemoradiotherapy (CCRT) versus cisplatin-based CCRT for patients with locally advanced nasopharyngeal carcinoma (LA-NPC).

Methods

We systematically searched PubMed, the Cochrane Library and Embase until February 29, 2020, for eligible randomized controlled trials (RCTs). The quality of the studies was assessed with the Cochrane Collaboration risk of bias tool. The following outcomes of interest were analyzed: 1) progression-free survival (PFS); 2) overall survival (OS); 3) distant metastasis-free survival (DMFS); 4) locoregional failure-free survival (LRFFS); and 5) any grade 3 or 4 treatment-related adverse events (AEs). The data were pooled with the use of hazard ratios (HRs) or odds ratios (ORs). Subgroup, heterogeneity and sensitivity analyses were performed.

Results

After screening all studies selected from the initial search, seven trials with 2233 patients met the inclusion criteria. Compared to cisplatin-based CCRT alone, there was reliable evidence that IC significantly improved PFS (HR 0.65, 95% CI 0.55–0.75, P < 0.00001), OS (HR 0.61, 95% CI 0.45–0.83, P = 0.002), DMFS (HR 0.65, 95% CI 0.53–0.79, P < 0.0001) and LRFFS (HR 0.68, 95% CI 0.53–0.88, P = 0.003) and was associated with a markedly increased risk of AEs (grade 3/4) during the IC and CCRT phases. No significant difference in the incidence of late AEs (grade 3/4) was observed between different arms.

Conclusion

Compared to cisplatin-based CCRT alone, IC followed by cisplatin-based CCRT confers real and substantial favorable survival outcomes with controllable toxicities. Therefore, it is reasonable to define IC followed by cisplatin-based CCRT as one of the standard treatment strategies for patients with LA-NPC.

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Authors and Affiliations

  1. Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China

    Min Tang & Ju Zhang

  2. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China

    Zhongxiong Jia

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  1. Min Tang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MT, ZJ and JZ. The first draft of the manuscript was written by Min Tang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ju Zhang.

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Tang, M., Jia, Z. & Zhang, J. The evaluation of adding induction chemotherapy to concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: a meta-analysis. Eur Arch Otorhinolaryngol 278, 1545–1558 (2021). https://doi.org/10.1007/s00405-020-06218-x

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  • DOI: https://doi.org/10.1007/s00405-020-06218-x

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