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Meta-Analysis
. 2010 Oct 15:10:558.
doi: 10.1186/1471-2407-10-558.

The role of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma among endemic population: a meta-analysis of the phase III randomized trials

Li Zhang  1 , Chong Zhao, Bijesh Ghimire, Ming-Huang Hong, Qing Liu, Yang Zhang, Ying Guo, Yi-Jun Huang, Zhong-Zhen Guan
Affiliations
Meta-Analysis

The role of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma among endemic population: a meta-analysis of the phase III randomized trials

Li Zhang et al. BMC Cancer. .

Abstract

Background: The main objective of this meta-analysis was to determine the clinical benefit of concurrent chemoradiotherapy (CCRT) compared with radiation alone (RT) in the treatment of nasopharyngeal carcinoma (NPC) patients in endemic geographic areas.

Methods: Using a prospective meta-analysis protocol, two independent investigators reviewed the publications and extracted the data. Published randomized controlled trials (RCTs) in which patients with NPC in endemic areas were randomly assigned to receive CCRT or RT alone were included.

Results: Seven trials (totally 1608 patients) were eligible. Risk ratios (RRs) of 0.63 (95% CI, 0.50 to 0.80), 0.76 (95% CI, 0.61 to 0.93) and 0.74 (95% CI, 0.62 to 0.89) were observed for 2, 3 and 5 years OS respectively in favor of the CCRT group. The RRs were larger than that detected in the previously reported meta-analyses (including both endemic and non-endemic), indicating that the relative benefit of survival was smaller than what considered before.

Conclusions: This is the first meta-analysis of CCRT vs. RT alone in NPC treatment which included studies only done in endemic area. The results confirmed that CCRT was more beneficial compared with RT alone. However, the relative benefit of CCRT in endemic population might be less than that from previous meta-analyses.

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Figures

Figure 1
Figure 1
A flow chart showing the selection of the trials.
Figure 2
Figure 2
Two, Three and Five years Overall Survival of CCRT vs. RT. Forest plot of the risk ratio (RR) of the 2 years, 3 years and 5 years OS with radiotherapy (RT) alone versus radiotherapy plus concurrent chemotherapy (CCRT). The estimate of the RR of each individual trial corresponds to the middle of squares and the horizontal line gives 95% CI. The closed diamond shows the overall RR with its 95%CI. RR less than 1 indicated improved survival for the CCRT compared with RT alone.
Figure 3
Figure 3
Three years Overall Survival of RT alone vs. CCRT with and/or without AC. Forest plots of the risk ratio (RR) of the 3 years OS with RT alone vs. pure CCRT and 3 years OS with RT alone vs. CCRT + AC. The estimate of the RR of each individual trial corresponds to the middle of squares and the horizontal line gives 95% CI. The closed diamond shows the overall RR with its 95%CI. RR less than 1 indicated improved survival for pure CCRT with or without AC compared with RT alone. Kwong_AB: In Kwong's trial, for subgroup analysis with pure CCRT vs. RT, group A and B were compared. Kwong_AD: In Kwong's trial, for subgroup analysis with adjuvant groups, A and D were compared.
Figure 4
Figure 4
Three years Locoregional control failure with RT alone vs. CCRT with and/or without AC Forest plot of the risk ratio (RR) of 3 years locoregional control failure with RT alone versus CCRT with and/or without AC. The estimate of the RR of each individual trial corresponds to the middle of squares and the horizontal line gives 95% CI. The closed diamond shows the overall RR with its 95%CI. RR less than 1 indicated improved survival for the CCRT compared with RT alone. Kwong_AB: In Kwong's trial, for subgroup analysis with pure CCRT vs. RT, groups A and B were compared. Kwong_AD: In Kwong's trial, for subgroup analysis with adjuvant groups, A and D were compared.
Figure 5
Figure 5
Three years Distant metastasis rates with RT alone versus CCRT with and/or without AC. Forest plot of the risk ratio (RR) for 3 years distant metastasis with RT alone versus CCRT with and/or without AC. The estimate of the RR of each individual trial corresponds to the middle of squares and the horizontal line gives 95% CI. The closed diamond shows the overall RR with its 95%CI. RR less than 1 indicated improved survival for the CCRT compared with RT alone. Kwong_AB: In Kwong's trial, for subgroup analysis with pure CCRT vs. RT, groups A and B were compared. Kwong_AD: In Kwong's trial, for subgroup analysis with adjuvant groups, A and D were compared.
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References

    1. Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16:1310–1317. - PubMed
    1. Huncharek M, Kupelnick B. Combined chemoradiation versus radiation therapy alone in locally advanced Nasopharyngeal carcinoma. Results of a meta-analysis of 1,528 patients from six randomized trials. Am J Clin Oncol (CCT) 2002;25:219–223. doi: 10.1097/00000421-200206000-00002. - DOI - PubMed
    1. Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol. 2004;15:4604–4612. doi: 10.1200/JCO.2004.10.074. - DOI - PubMed
    1. Chua DT, Ma J, Sham JS, Mai HQ, Choy DT, Hong MH, Lu TX, Min HQ. Long-term survival after cisplatin based induction chemotherapy and radiotherapy for Nasopharyngeal carcinoma: A pooled data analysis of two phase III trials. J Clin Oncol. 2005;23:1118–1124. doi: 10.1200/JCO.2005.12.081. - DOI - PubMed
    1. Baujat B, Audry H, Bourhis J, Chan AT, Onat H, Chua DT, Kwong DL, Al-Sarraf M, Chi KH, Hareyama M, Leung SF, Thephamongkhol K, Pignon JP. MAC-NPC Collaborative Group. Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys. 2006;64:47–56. - PubMed

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