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Comparative Study
. 2019 Jul 10;14(7):e0219611.
doi: 10.1371/journal.pone.0219611. eCollection 2019.

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

Taifeng Du  1 , Jiefeng Xiao  1 , Zhaolong Qiu  1 , Kusheng Wu  1
Affiliations
Comparative Study

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

Taifeng Du et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Process of identifcation and selection of relevant articles in this meta-analysis.
Fig 2
Fig 2. Forest plot of comparison between IMRT and 2D-RT for survival outcomes.
Fig 3
Fig 3. Forest plot of comparison between IMRT and 2D-RT for late toxicities.
Fig 4
Fig 4
Funnel plots of publication bias summary for meta-analysis of 5-year OS (A), 5-year LRFS (B), 5-year PFS (C), 5-year DMFS (D), late xerostomia (E), trismus (F), and TLN (G).
See this image and copyright information in PMC

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