The effectiveness of intensity-modulated radiation therapy versus 2D-RT for the treatment of nasopharyngeal carcinoma: A systematic review and meta-analysis

Abstract

Background At present, the management of nasopharyngeal carcinoma (NPC) is mainly based on radiotherapy, but there are many radiation delivery techniques such as intensity-modulated radiotherapy (IMRT) and 2-dimensional radiotherapy (2D-RT). Materials and methods We searched all the eligible studies through the PubMed, Cochrane Library, Medline, and Embase. The endpoint events in meta-analysis were overall survival (OS), tumor local control including local-regional free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS), and late toxicities. Results A total of ten publications met the criteria and were identified through searches of the databases and references. We included 13304 patients in the meta-analysis, of whom 5212 received IMRT and 8092 were allocated to 2D-RT alone group. Compared with 2D-RT treatment, the IMRT group was associated with a better 5-year OS (OR = 1.70; 95% CI = 1.36–2.12), LRFS (OR = 2.08; 95% CI = 1.82–2.37), and PFS (OR = 1.40; 95% CI = 1.26–1.56). Additionally, the incidence of late toxicities such as late xerostomia (OR = 0.21; 95% CI = 0.09–0.51), trismus (OR = 0.16; 95% CI = 0.04–0.60), and temporal lobe neuropathy (TLN) (OR = 0.40; 95% CI = 0.24–0.67) for NPC patients in IMRT group were significantly lower than 2D-RT. Conclusions The meta-analysis demonstrates that IMRT provides improved long-term tumor overall survival and local control including LRFS and PFS. Additionally, IMRT yields a lower incidence of late toxicities induced by irradiation in NPC patients. Compared to 2D-RT, IMRT may be an effective treatment for patients with NPC. Further intensive studies should be pursued to examine the association.

Assessment of Nasopharyngeal Cancer in Young Patients Aged ≤ 30 Years

“…These values were significantly higher than those in the conventional radiation therapy group (23). In a meta-analysis, including 13,304 patients with NPC, Du et al (24), reported that the IMRT group was associated with a better 5-year OS (OR = 1.70; 95% CI = 1.36–2.12), tumor local control including local–regional free survival (OR = 2.08; 95% CI = 1.82–2.37), and progression-free survival (OR = 1.40; 95% CI = 1.26–1.56). IMRT is also associated with lower radiation toxicity, such as xerostomia, hearing loss, trismus and temporal lobe neuropathy.…”

Nongaussian Intravoxel Incoherent Motion Diffusion Weighted and Fast Exchange Regime Dynamic Contrast-Enhanced-MRI of Nasopharyngeal Carcinoma: Preliminary Study for Predicting Locoregional Failure

“…The role of chemotherapy regimens, proton therapy, and EBV-directed adjuvant therapy is still being evaluated [ 4 , 5 , 6 ]. Intensity-modulated radiotherapy (RT) has allowed precise targeting as well as a reduction in toxicity through sparing of normal tissue [ 7 , 8 , 9 , 10 ]. Due to the deep anatomic location and proximity to critical structures, treatment (TX) is still associated with toxicities [ 11 ].…”

Analysis of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma

“…In the last 20 years, IMRT has allowed an increase in the dose of radiation applied to tumor lesions, while reducing radiotherapy-related toxicity to surrounding organs. Previous studies have shown that IMRT reduced the 5-year LRFS compared with conventional techniques, [ 5 – 7 ] and patients with NPC receiving IMRT had a 5-year overall survival (OS) of 75% to 83%, a DSS of 79% to 85%, a LRFS of 90% to 95%, and DMFS of 85% to 90%.…”