A network meta-analysis for efficacies and toxicities of different therapeutic regimens in the treatment of advanced nasopharyngeal carcinoma

Tingyu Li; Fan Yang; Kening Ma; Lijie Lv

doi:10.1007/s00405-020-06593-5

A network meta-analysis for efficacies and toxicities of different therapeutic regimens in the treatment of advanced nasopharyngeal carcinoma

Eur Arch Otorhinolaryngol. 2021 Sep;278(9):3333-3344. doi: 10.1007/s00405-020-06593-5. Epub 2021 Jan 31.

Authors

Tingyu Li¹, Fan Yang², Kening Ma³, Lijie Lv⁴

Affiliations

¹ Department of Medical Care, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China.
² Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China.
³ Department of Pain, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China.
⁴ Department of Medical Care, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China. lvlj@jlu.edu.cn.

PMID: 33517538
DOI: 10.1007/s00405-020-06593-5

Abstract

Purpose: The current study set out to compare the efficacies and toxicities (grad 3 and 4) between concurrent chemoradiotherapy (CCRT), induction chemotherapy plus radiotherapy (IC + RT), IC + CCRT, RT and CCRT + adjuvant chemotherapy (CCRT + AC) in regard to advanced nasopharyngeal carcinoma (NPC) treatment using a network meta-analysis.

Methods: Literature retrieval was conducted using PubMed, Cochrane Library and other English databases. Eligible randomized controlled trails (RCTs) of 5 different regimens were included. The network meta-analysis combined direct and indirect comparisons to measure pooled odd ratios (OR) and the surface under the cumulative ranking curves (SUCRA).

Results: A total of eight eligible RCTs were enrolled into this network meta-analysis after initial exclusion. With respect to hematologic toxicity, CCRT + AC exhibited higher toxicity in patients with advanced NPC in terms of anemia and leukopenia/neutropenia compared to RT. As for anemia, the toxicity of IC + CCRT was higher than those with advanced NPC. In addition, CCRT exhibited higher toxicity than RT in relation to leukopenia/neutropenia. Non-hematologic toxicity in regard to nausea/vomiting suggested that CCRT, IC + CCRT and CCRT + AC presented with higher levels of toxicity in patients with advanced NPC, in contrast to RT. Lastly, RT was found to be less toxic but with higher five-year overall survival (OS) rate in patients with advanced NPC, while CCRT, IC + CCRT and CCRT + AC were more toxic in patients with advanced NPC.

Conclusion: Among the five therapeutic regimens, the survival rate of IC + RT was similar to that of CCRT, and the toxicity SUCRA value of IC + RT was lower than that of CCRT. Together, our findings indicate that IC + RT may be a potentially acceptable treatment alternative to CCRT for advanced NPC, and is worthy of further investigation.

Keywords: Advanced nasopharyngeal carcinoma; Bayesian network model; Chemotherapy; Efficacy; Radiotherapy; Randomized controlled trials; Toxicity.

Publication types

Meta-Analysis

MeSH terms

Antineoplastic Combined Chemotherapy Protocols
Chemoradiotherapy / adverse effects
Humans
Induction Chemotherapy
Nasopharyngeal Carcinoma / therapy
Nasopharyngeal Neoplasms* / drug therapy
Network Meta-Analysis