Survival benefit of induction chemotherapy in treatment for locally advanced nasopharyngeal carcinoma – A time-to-event meta-analysis

Song, Yu; Wang, Wanwei; Tao, Guangzhou; Zhou, Xiangxiang

doi:10.1016/j.oraloncology.2015.05.006

Cited by 25 publications

(32 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results were in line with previous reports [6, 36]. Regarding DFFS, the leave-1-out sensitivity analysis showed that the positive finding relied heavily on the trial conducted by Ma et al [14].…”

Section: Discussionsupporting

confidence: 92%

“…Consistent with previous studies [5–6], this meta-analysis showed that the addition of NACT before CCRT significantly improved PFS. The improvement in PFS was consistent across all trials [9, 13–20], despite a marked variability in terms of NACT regimen, duration of follow-up, radiotherapy technique, method of data extraction, and staging system for nasopharyngeal carcinoma in the included trials.…”

Section: Discussionsupporting

confidence: 91%

“…Four meta-analyses directly [5–6] or indirectly [7–8] showed that NACT plus CCRT did not improved OS compared versus CCRT or CCRT with AC in patients with locoregionally advanced nasopharyngeal carcinoma. However, the largest pair-wise comparison included only 4 trials with a total of 798 patients [6], so these meta-analyses were underpowered by a small sample size [5–8]. In addition, the primary endpoint of all these meta-analyses was OS [5–8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Significant benefits of adding neoadjuvant chemotherapy before concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized controlled trials

Wang

Tian

Li³

et al. 2016

Oncotarget

View full text Add to dashboard Cite

PurposeWe did a meta-analysis to compare the efficacy and safety of neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) versus CCRT with or without adjuvant chemotherapy (AC) for patients with locoregionally advanced nasopharyngeal carcinoma based on randomized controlled trials.MethodsWe searched PubMed, Embase, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure, and meeting proceedings of major relevant conferences to identify published and unpublished randomized controlled trials. Progression-free survival (PFS) was the primary endpoint.ResultsThis meta-analysis included 9 randomized clinical trials with 2215 patients. NACT followed by CCRT significantly improved PFS (HR=0.68, 95% CI 0.56 – 0.81, P < 0.001) compared versus CCRT with or without AC, and no heterogeneity was observed (I2 = 0.0%, P = 0.975). NACT was associated with a significant improvement in overall survival (HR = 0.64, 95% CI 0.49 – 0.84, P = 0.001; I2 = 0.0%, P = 0.467) and distant failure-free survival (HR = 0.72, 95% CI 0.53 – 0.97, P = 0.031; I2 = 0.0%, P = 0.744). No significant benefit was shown by NACT for locoregional control. NACT with CCRT increased risks of grade 3 – 4 anemia, thrombocytopenia, leukopenia, and fatigue, compared versus CCRT with or without AC.ConclusionsOur meta-analysis confirmed that the addition of NACT to CCRT significantly improved PFS and OS versus CCRT with or without AC for locoregionally advanced nasopharyngeal carcinoma. These results may alter the standard of care - CCRT with or without AC, for locoregionally advanced nasopharyngeal carcinoma.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Significant benefits of adding neoadjuvant chemotherapy before concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized controlled trials

Wang

Tian

Li³

et al. 2016

Oncotarget

View full text Add to dashboard Cite

show abstract

“…For locoregional advanced NPC, chemoradiation is the standard of care [1, 12, 16, 17]. Despite recent progress in radiotherapy and chemotherapy, local residual and recurrent disease remains challenging.…”

Section: Discussionmentioning

confidence: 99%

PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

Liu

Wang

et al. 2017

Radiat Oncol

View full text Add to dashboard Cite

BackgroundThe effect of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT)-guided dose-painting intensity-modulated radiation therapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (NPC) is unclear. This study aimed to assess the efficacy and toxicity of such combination.MethodsFrom 2012 to 2014, 213 patients with stage III-IVB NPC received chemoradiotherapy by PET/CT-guided DP-IMRT (group A, n = 101) or CT-based IMRT (group B, n = 112). In group A, subvolume GTVnx-PET (gross tumor volume of nasopharynx in PET images) was defined within GTVnx (gross tumor volume of nasopharynx) as the SUV50%max isocontour; the dose to GTVnx-PET was escalated to DT 75.2 Gy/32 and 77.55 Gy/33 Fx, respectively, for patients with T1-2 and T3-4 disease, respectively. In group B, PGTVnx was irradiated at DT 70.4–72.6 Gy/32–33 Fx in 2.2 Gy per fraction.ResultsComplete response rates were 99.0% (100/101) and 92.9% (104/112) in groups A and B, respectively (P = 0.037). Compared with CT-based IMRT, FDG-PET/CT guided DP-IMRT significantly improved 3-year local failure-free survival (LFFS, 98.8% vs. 91.3%; P = 0.032), locoregional failure-free survival (LRFFS, 97.2 vs. 91.2%; P = 0.049), distant metastasis-free survival (DMFS, 92.9% vs. 87.4%; P = 0.041), disease free survival (DFS, 87.9% vs. 82.4%; P = 0.02), and overall survival (OS, 91.8% vs. 82.6%; P = 0.049). No statistically significant differences in acute and late toxic effects were observed. Multivariate analysis showed that dose painting (PET/CT-guided DP-IMRT vs CT-based IMRT without DP) was a significant independent prognostic factor for LFFS and DFS.ConclusionFDG-PET/CT guided DP-IMRT plus chemotherapy is associated with a considerable survival benefit, without increasing toxicity in patients with locoregional advanced NPC. Further randomized trials are needed to fully assess the role of PET/CT-guided DP-IMRT.

show abstract

“…There have been many comparative studies to investigate the roles of the additional IC or AC to RT alone or CCRT Less is more: role of additional chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal cancer management https://doi.org/10.3857/roj.2019.00311 settings, typically through the phase 3 randomized controlled trial (RCT). And, based on these trials, several important metaanalysis reports have been published recently [1][2][3][4][5][6][7][8][9][10][11]. The most recent guideline by the National Comprehensive Cancer Network (NCCN) on the treatment of stage II-IVb nasopharynx cancer highly recommends the clinical trials, and listed two options of IC + CCRT and CCRT + AC as category 2a, while CCRT alone as category 2b, respectively [12].…”

Section: Introductionmentioning

confidence: 99%

Less is more: role of additional chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal cancer management

Ahn

2019

Radiat Oncol J

View full text Add to dashboard Cite

Concurrent chemoradiation therapy (CCRT) has played the most important and central role in the definitive therapy for the patients with locoregionally advanced stage nasopharynx cancer. The addition of induction chemotherapy (IC) or adjuvant chemotherapy (AC) to CCRT have been widely accepted with the rationale of improving distant control in the clinical practices. This review article investigated the role of IC and AC based on 11 recent meta-analysis publications, and found that the clinical benefits obtained by the additional IC or AC to CCRT, at the cost of the increased risks of more frequent and more severe side effects, seemed not big enough. More intervention is not always better, however, less seems frequently good enough. The author would speculate that 'less is more' and would advocate CCRT alone as the current standard.

show abstract

Survival benefit of induction chemotherapy in treatment for locally advanced nasopharyngeal carcinoma – A time-to-event meta-analysis

Cited by 25 publications

References 16 publications

Significant benefits of adding neoadjuvant chemotherapy before concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized controlled trials

Significant benefits of adding neoadjuvant chemotherapy before concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized controlled trials

PET/CT-guided dose-painting versus CT-based intensity modulated radiation therapy in locoregional advanced nasopharyngeal carcinoma

Less is more: role of additional chemotherapy to concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal cancer management

Contact Info

Product

Resources

About