Survival benefit of induction chemotherapy in treatment for locally advanced nasopharyngeal carcinoma--A time-to-event meta-analysis

Abstract

Objectives: This paper aims to compare the longtime efficacy of induction chemotherapy followed by concurrent chemoradiotherapy (IC+CCRT) and concurrent chemoradiotherapy (CCRT) alone in locally advanced nasopharyngeal carcinoma (LANPC) by using time-to-event data based on randomized controlled trials (RCTs).

Materials and methods: We searched all RCTs comparing the efficacy between IC+CCRT and CCRT of LANPC in major medical databases including Pubmed, web of science, cochrane, China National Knowledge Internet Web (CNKI), Wanfang, and VIP. The Hazard ratios (HR) of time-to-event data on overall survival (OS), progressive free survival (PFS), distant metastasis failure-free survival (D-FFS), and loco-regional failure-free survival (L-FFS) from the enrolled studies were calculated for this meta analysis. Our primary endpoints were OS, PFS, D-FFS, and L-FFS.

Results: Four studies with 798 patients were enrolled for this paper. Compared with in CCRT alone, HRs (95% confidence interval) of OS, PFS, D-FFS and L-FFS were 0.52 (0.21-1.29), 0.66 (0.49-0.90), 0.60 (0.39-0.98) and 0.66 (0.16-2.65) respectively in IC+CCRT.

Conclusions: Induction chemotherapy could significantly reduce the hazard of progression and distant metastasis in LANPC on the basis of concurrent chemoradiotherapy, but do less with the hazard of overall death and loco-regional failure.

Keywords: Concurrent chemoradiotherapy; Induction chemotherapy; Meta-analysis; Nasopharyngeal carcinoma; Time-to-event.