Concurrent chemoradiotherapy was associated with a higher severe late toxicity rate in nasopharyngeal carcinoma patients compared with radiotherapy alone: a meta-analysis based on randomized controlled trials

Abstract

BackgroundTo investigate the incidence and risk of severe late toxicity with concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma patients.MethodsEligible studies included prospective randomized controlled trials (RCTs) evaluating CCRT versus radiotherapy alone in patients with nasopharyngeal carcinoma and in which data on severe late toxicities were available. Random effects or fixed effect models were applied to obtain the summary incidence, relative risks (RRs) and 95% confidence intervals (CIs).ResultsFive RCTs with 1102 patients with NPC were included in this analysis. The summary incidence of overall severe late toxicities in patients receiving CCRT was 30.7% (95% CI, 18–47.2%) and the incidence of radiotherapy alone group was 21.7% (95% CI, 13.3–33.4%). The use of concurrent chemotherapy was associated with an increased risk of severe late toxicities, with a RR of 1.349 (95% CI, 1.108–1.643; P = 0.005). As for specific late toxicity, CCRT significantly increased the risk of ear deafness/otitis (RR = 1.567; 95% CI, 1.192–2.052), but other late toxicities were not significantly different. Patients receiving concurrent chemotherapy regimens with 3-week high-dose cisplatin (HC) have a higher risk of ear deafness/otitis (RR = 1.672; 95% CI, 1.174–2.382; P = 0.026). However, there was no significant increase in the RR of severe ear complication with the addition of non-3-week high-dose cisplatin (nonHC) regimens (RR = 1.433; 95% CI, 0.946–2.171; P = 0.095).ConclusionWith the present evidence, the addition of concurrent chemotherapy seems to increase the risk of severe late toxicities in patients with NPC, especially when using HC regimen for the occurrence of severe ototoxicity.

Concurrent chemoradiotherapy by simultaneously integrated boost volumetric‐modulated arc therapy for nasopharyngeal carcinoma‐toxicity/quality of life and survival

“…[5][6][7] Cisplatin and irradiation are known to be toxic to hearing and ototoxicity remains one the most commonly encountered late toxicities for NPC patients treated by CCRT. 25 The incidence rate of developing severe (grade 3 or more) ototoxicity in our series is low (4 year cumulative incidence rate: 3.0%), which was non-inferior to other NPC series treated by CCRT with SIB-VMAT (0%), 26 or CCRT with SIB-IMRT (2.0%). 23 As regards the radiation neuropathy, 1 patient (1.4%) had optic neuropathy so far, but 3 patients (4.4%) developed temporal lobe necrosis, which was mild with limited follow-up.…”

“…In addition to parotid sparing, SIB‐VMAT also provides dosimetric benefits in the critical structures of skull base, temporal lobe, and ear structure for NPC planning . Cisplatin and irradiation are known to be toxic to hearing and ototoxicity remains one the most commonly encountered late toxicities for NPC patients treated by CCRT . The incidence rate of developing severe (grade 3 or more) ototoxicity in our series is low (4 year cumulative incidence rate: 3.0%), which was non‐inferior to other NPC series treated by CCRT with SIB‐VMAT (0%), or CCRT with SIB‐IMRT (2.0%) .…”

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

“…Therefore, radiotherapy plays an important role in the treatment of NPC due to its special anatomical position. 6 A strong relationship between radiotherapy and leucopenia has been reported in the literature-65.6% patients with NCP developed mild leucopenia (grade 1-2) and 21.1% developed severe leucopenia (grade 3-4) during treatment. 3 In addition, compared with radiotherapy alone, the overall 10-year survival rate of concurrent chemoradiotherapy (CCRT) is significantly improved.…”

“…5 Study showed that the incidence of side effects of CCRT was significantly higher than that of radiotherapy alone (30.7% vs 21.7%). 6 A strong relationship between radiotherapy and leucopenia has been reported in the literature-65.6% patients with NCP developed mild leucopenia (grade 1-2) and 21.1% developed severe leucopenia (grade 3-4) during treatment. 7 Till date, most studies on oral nutrition supplementations (ONS) of patients with NCP during CCRT focused on improvement of nutritional status, 8 whereas information is lacking on prevention of myelosuppression which could profoundly affect the progress of CCRT immediately, and even lead to the termination of treatment.…”

Benefit of percutaneous endoscopic gastrostomy in patients undergoing definitive chemoradiotherapy for locally advanced nasopharyngeal carcinoma

“…Concurrent chemoradiotherapy (CCRT) is the standard treatment for locoregional advanced NPC (LA-NPC) 3,4. Unfortunately, CCRT is associated with significant treatment-related toxicities, including mucositis, odynophagia, dysphagia, xerostomia, and vomiting 5,6. These complications can put patients at risk of malnutrition, thereby compromising treatment tolerance and efficacy, and increasing health care costs 7.…”