ABSTRACT
Objective:To compare the efficacy and adverse events of induction chemotherapy combined with radiotherapy alone (IC+ RT) and induction chemotherapy combined with concurrent chemoradiotherapy (IC+ CCRT) for nasopharyngeal carcinoma in the era of intensity-modulated radiation therapy in this Meta-analysis.Methods:Retrospective or randomized controlled clinical studies published between 2010 and 2020 were searched from the Cochrane Library, PubMed, and Web of Science databases. The selected studies included nasopharyngeal carcinoma patients treated with IC+ CCRT or IC+ RT. STATA 12 software was used to combine the hazard ratio (HR), risk ratio (RR) and 95% confidence interval (CI), and random or fixed effect models were used for statistical analysis.Results:A total of 2483 patients from eight retrospective studies were included. The overall survival in the IC+ CCRT group was similar to that in the IC+ RT group ( HR=0.78, 95% CI: 0.58-1.04, P=0.091). However, the distant metastasis-free survival ( HR=0.56, 95% CI: 0.42-0.74, P<0.001) and progression-free survival ( HR=0.65, 95% CI: 0.54-0.77, P<0.001) were improved in the IC+ CCRT group compared with those in the IC+ RT group. In terms of adverse reactions, the acute adverse reactions in the IC+ CCRT group were increased significantly compared with those in the IC+ RT group. Conclusions:In the treatment of nasopharyngeal carcinoma, the overall survival of two treatment modes is similar, but the distant metastasis-free survival and progression-free survival in the IC+ CCRT group are better than those in the IC+ RT group, whereas the incidence of adverse reactions is also increased. IC+ CCRT may be a recommended treatment for nasopharyngeal carcinoma patients, but more research is needed.
ABSTRACT
Objective To retrospectively compare the efficacy and toxicity between intensity?modulated radiotherapy ( IMRT ) combined with chemotherapy plus targeted therapy and IMRT combined with chemotherapy in the treatment of patients with locally advanced nasopharyngeal carcinoma ( NPC) , and to preliminarily evaluate the necessity of adding targeted drugs to standard chemoradiotherapy . Methods Forty?two patients with stage Ⅲ?Ⅳb NPC who received IMRT combined with concurrent ± adjuvant chemotherapy plus targeted molecular therapy from January 2007 to December 2012 were assigned to experiment group,while 168 patients who received IMRT combined with concurrent ±adjuvant chemotherapy within the same period were assigned to control group. The experiment group was paired with the control group at a ratio of 1vs.4.The survival rates were caculated using Kaplan?Meier method and analyzed using log?rank method,other comparison was perfomed by χ2?test. Results The follow?up rate was 100%.The sample size of experiment group and control group were 42 patients and 168 patients. There were no significant differences in the 3?year OS, LRFS, or DMFS rates between the experiment group and the control group (94?3% vs. 87?3%, P=0?647;100?0% vs. 94?6%,P=0?193;92?2% vs. 89?1%, P=0?744).There were also no significant differences in the incidence rates of grade Ⅲ?Ⅳ gastrointestinal reaction or marrow suppression between the two groups ( 7?1%( 3/42 ) vs. 3?6%( 6/168 ) , P=0?388;26?2%( 11/42 ) vs. 17?3%(29/168),P=0?272).However,the experiment group had significantly higher incidence of grade Ⅲ?Ⅳoral mucositis than the control group ( 40?5%( 17/42 ) vs . 14?9%( 25/168 ) , P=0?000 ) . Conclusions The preliminary results indicate that IMRT combined with chemotherapy plus targeted molecular therapy is not able to substantially improve the OS, LRFS, or DMFS rates in patients with locally advanced NPC. Moreover, it may aggravate radiochemotherapy?induced oral mucositis.
ABSTRACT
Objective To compare the 7th edition of International Union Against Cancer ( UICC) staging system with the Chinese 2008 staging system for nasopharyngeal carcinoma ( NPC) , and to provide evidence for further updating of the staging system. Methods A retrospective analysis was performed among 767 patients who were pathologically and newly diagnosed with non?metastatic NPC and treated with intensity?modulated radiotherapy from 2006 to 2012. Based on the main prognostic indices, overall survival ( OS) , locoregional failure?free survival( LFFS) local relapse?free survival ( LRFS) , and distant metastasis?free survival ( DMFS) rates, the value of T stage, N stage, and clinical stage in prognostic prediction was compared between the two staging systems. The Kaplan?Meier method was used for calculating survival rates. The log?rank test was used for survival difference analysis. The Cox model was used for multivariate prognostic analysis. Results In terms of T stage, the Chinese 2008 staging system was a significantly better predictor of the OS and LRFS rates than the 7th edition of UICC staging system. In terms of N stage, they were comparable in the prediction of the OS and DMFS rates. In terms of clinical stage, the 7th edition of UICC staging system was a significantly better predictor of the OS rate than the Chinese 2008 staging system. For the new staging system proposed based on the statistical results, the T, N, and clinical staging gave significantly better prognostic prediction. Conclusions The 7th edition of UICC staging system and the Chinese 2008 staging system for NPC have their own advantages in prognostic prediction. The new staging system proposed in this study could contribute to the updating of the current staging system for NPC.