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

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.

Survival after induction chemotherapy in locoregional advanced nasopharyngeal carcinoma: An updated systematic review and meta‐analysis

“…Therefore, the treatment side effects and other related profiles are not revealed in the results. However, the current meta‐analytic results reconfirmed the significant benefits for survival of patients with locoregionally advanced NPC seen in previous meta‐analyses 26–35 . Therefore, the benefits of ICT for the survival condition of locoregionally advanced NPC might be consistent and persuasive.…”

“…Our meta‐analysis enrolled the latest studies evaluating ICT with CCRT for patients with locoregionally advanced NPC 18,19,24 . The results might be more updated than previous meta‐analyses 26–31 . We also analyzed more survival indicators than the previous meta‐analyses 27–29 .…”

“…The benefits of the OS, PFS, DMFS, and LRRFS might be related to role of ICT in eliminating micro‐metastases at the initial treatment. they can enhance the local control of locoregionally advanced NPC through a combination of CCRT 31 . In addition, ICT might inhibit the implantation of tumor cells and kill the tumor cells in systemic circulation.…”

The efficacy and safety of concurrent chemoradiotherapy with induction chemotherapy vs. concurrent chemoradiotherapy alone for locally advanced nasopharyngeal carcinoma: a systematic-review and meta-analysis

“…However, another study by Zhang et al ( 7 ) has suggested that for specific patients (NPC with chronic hepatitis B infection), IC does not provide a significant efficacy gain for CCRT, but increases the toxicity and liver burden. A meta-analysis is the best way to resolve the controversies ( 8 ). Therefore, we conducted this meta-analysis to further explore the efficacy and safety of IC + CCRT vs. CCRT alone, and we also tried to perform subgroup analysis of different stages of LNC, different age levels, and different IC chemotherapy regimens.…”

Induction chemotherapy with paclitaxel, carboplatin and cetuximab for locoregionally advanced nasopharyngeal carcinoma: A single-center, retrospective study

“…Surprisingly, several prospective studies have shown that IC consistently results in higher response and exerts a pronounced effect on survival and distant metastasis ( 4 – 7 ). A meta-analysis also showed that the addition of IC to CRT improved progression-free survival (PFS) and overall survival (OS) ( 8 – 10 ). Based on these findings, platinum-based IC, herein the combination of docetaxel (DTX), cisplatin (CDDP), and fluorouracil (TPF) and gemcitabine (GEM)+CDDP (GP) followed by CRT, are now considered standard therapy over CRT alone for this patient population ( 4 , 5 ).…”