Comparison of Induction Chemotherapy Plus Concurrent Chemoradiotherapy and Concurrent Chemoradiotherapy Alone in Locally Advanced Nasopharyngeal Carcinoma

Guoqiang Xu; Qiaoli Wang; Xingrao Wu; Chunyan Lv; Guilin Zeng; Zhihong Xue; Ruixue Cao; Nan Zhang; Wei Xiong; Qin Huang

doi:10.1177/1533033821990017

Comparison of Induction Chemotherapy Plus Concurrent Chemoradiotherapy and Concurrent Chemoradiotherapy Alone in Locally Advanced Nasopharyngeal Carcinoma

Technol Cancer Res Treat. 2021 Jan-Dec:20:1533033821990017. doi: 10.1177/1533033821990017.

Authors

Guoqiang Xu¹, Qiaoli Wang¹, Xingrao Wu¹, Chunyan Lv², Guilin Zeng³, Zhihong Xue³, Ruixue Cao¹, Nan Zhang², Wei Xiong¹, Qin Huang⁴

Affiliations

¹ Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
² Department of Head and Neck Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
³ Department of Oncology, Chengdu Fifth People's Hospital, Sichuan, China.
⁴ Teaching Affairs and Administration Department, Kunming Medical University, Chenggong District, Kunming, Yunnan Province, China.

Abstract

Purpose: Induction chemotherapy plus concurrent chemoradiotherapy and concurrent chemoradiotherapy alone are both standard treatment regimens for managing locally advanced nasopharyngeal carcinoma. 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 nasopharyngeal carcinoma.

Methods: We thoroughly searched the PubMed, EMBASE, and Cochrane Library databases and then merged the effect indicators of hazard ratios and risk ratios using RevMan 5.1.

Results: Seven randomized controlled trials totaling 2,319 patients were included in our research. The synthesized results showed that induction chemotherapy plus concurrent chemoradiotherapy improved overall survival (HR = 0.75, 95% CI: 0.63-0.89, P = 0.001), progression-free survival (HR = 0.69, 95% CI: 0.60-0.80, P < 0.001), distant metastasis-free survival (HR = 0.65, 95% CI: 0.53-0.80, P < 0.001) and locoregional recurrence-free survival (HR = 0.68 95%, CI: 0.54-0.86, P = 0.001) versus concurrent chemoradiotherapy alone. It also increased the risk of anemia, thrombocytopenia, and neutropenia during concurrent chemoradiotherapy. However, the incidence of leukopenia and mucositis was similar in induction chemotherapy and induction chemotherapy plus concurrent chemoradiotherapy. Furthermore, the subgroup analysis showed better survival outcomes with induction chemotherapy plus concurrent chemoradiotherapy than with concurrent chemoradiotherapy alone in the triweekly cisplatin subgroup (all P < 0.01), whereas induction chemotherapy plus concurrent chemoradiotherapy could only improve progression-free survival and locoregional recurrence-free survival in the weekly cisplatin subgroup (HR = 0.78, P = 0.02; and HR = 0.66, P = 0.03, respectively).

Conclusions: Induction chemotherapy plus concurrent chemoradiotherapy improved survival outcomes in patients with locally advanced nasopharyngeal carcinoma versus concurrent chemoradiotherapy. For the weekly cisplatin regimen subgroup, it did not improve remote control or overall survival versus concurrent chemoradiotherapy alone, warranting further clarification.

Keywords: chemoradiotherapy; induction chemotherapy; meta-analysis; nasopharyngeal neoplasms.

Publication types

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

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / adverse effects
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Chemoradiotherapy*
Combined Modality Therapy
Disease Management
Humans
Induction Chemotherapy
Nasopharyngeal Carcinoma / mortality
Nasopharyngeal Carcinoma / pathology*
Nasopharyngeal Carcinoma / therapy*
Neoplasm Staging
Prognosis
Publication Bias
Treatment Outcome