Open AccessA Pairwise Meta‐Analysis of Induction Chemotherapy in Nasopharyngeal Carcinoma
Author(s) -
OuYang PuYun,
Zhang XiaoMin,
Qiu XingSheng,
Liu ZhiQiao,
Lu Lixia,
Gao YuanHong,
Xie FangYun
Publication year - 2019
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2018-0522
Subject(s) - medicine , induction chemotherapy , nasopharyngeal carcinoma , hazard ratio , meta analysis , oncology , chemotherapy , randomized controlled trial , confidence interval , relative risk , chemoradiotherapy , radiation therapy , surgery
Background Locoregionally advanced nasopharyngeal carcinoma has high risk of distant metastasis and mortality. Induction chemotherapy is commonly administrated in clinical practice, but the efficacy was quite controversial in and out of randomized controlled trials. We thus conducted this pairwise meta‐analysis. Materials and Methods Trials that randomized patients to receive radiotherapy or concurrent chemoradiotherapy with or without induction chemotherapy were identified via searches of PubMed, MEDLINE, and ClinicalTrials.gov . Results A total of ten trials (2,627 patients) were included. The pooled hazard ratios (HRs) based on fixed effect model were 0.68 (95% confidence interval [CI] 0.56–0.80, p < .001) for overall survival (OS) and 0.70 (95% CI 0.61–0.79, p < .001) for progression‐free survival (PFS), which strongly favored the addition of induction chemotherapy. The absolute 5‐year survival benefits were 8.47% in OS and 10.27% in PFS, respectively. In addition, based on the available data of eight trials, induction chemotherapy showed significant efficacy in reducing locoregional failure rate (risk ratio [RR] = 0.81, 95% CI 0.68–0.96, p = .017) and distant metastasis rate (RR = 0.69, 95% CI 0.58–0.82, p < .001). Conclusion This pairwise meta‐analysis confirms the benefit in OS, PFS, and locoregional and distant controls associated with the addition of induction chemotherapy in nasopharyngeal carcinoma. Implications for Practice According to the results of this meta‐analysis of ten trials, induction chemotherapy can prolong overall survival and progression‐free survival and improve locoregional and distant controls for nasopharyngeal carcinoma.