The role of concurrent chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A systematic review and meta-analysis

PLoS One. 2018 Mar 22;13(3):e0194733. doi: 10.1371/journal.pone.0194733. eCollection 2018.

Abstract

Objectives: To compare clinical outcomes of concurrent chemoradiotherapy (CCRT) with those of radiotherapy alone for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy (IMRT) era.

Materials and methods: We comprehensively searched PubMed, Embase, and the Cochrane Library to identify eligible studies. Overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), locoregional recurrence-free survival (LRRFS) with hazard ratios (HRs), and toxicities with odd ratios (ORs) were analyzed.

Results: A total of seven studies met the criteria, with 1302 patients who were treated with IMRT alone or IMRT plus concurrent chemotherapy. No significant survival benefit was shown by CCRT regardless of OS (HR = 1.17, 95% CI 0.73-1.89, P = 0.508), PFS (HR = 0.76, 95% CI 0.38-1.50, P = 0.430), DMFS (HR = 0.89, 95% CI 0.33-2.41, P = 0.816), or LRRFS (HR = 1.03, 95% CI 0.95-1.12, P = 0.498). Additionally, CCRT notably increased the risk of acute grade 3-4 leukopenia (OR = 4.432, 95% CI 2.195-8.952, P < 0.001), compared to IMRT alone.

Conclusion: Adding concurrent chemotherapy to IMRT led to no survival benefit and increased acute toxicity reactions for stage II nasopharyngeal carcinoma.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma / diagnosis
  • Carcinoma / epidemiology
  • Carcinoma / pathology
  • Carcinoma / therapy*
  • Chemoradiotherapy* / methods
  • Chemoradiotherapy* / statistics & numerical data
  • Disease-Free Survival
  • Humans
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / diagnosis
  • Nasopharyngeal Neoplasms / epidemiology
  • Nasopharyngeal Neoplasms / pathology
  • Nasopharyngeal Neoplasms / therapy*
  • Neoplasm Staging
  • Prognosis
  • Radiotherapy, Intensity-Modulated* / standards
  • Radiotherapy, Intensity-Modulated* / statistics & numerical data
  • Retrospective Studies
  • Survival Analysis

Grants and funding

This work was sponsored by the Major programs of Sichuan Science and Technology Department (No. 2017SZ0015). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.