European Archives of Oto-Rhino-Laryngology | 2021
Which treatment is better than concurrent chemoradiotherapy about survival for stage III or IV locally advanced nasopharyngeal carcinoma? An updated Bayesian network meta-analysis of randomized controlled trials
Abstract
To speculate whether induction chemotherapy (IC) or adjuvant chemotherapy (AC) with concurrent chemoradiotherapy (CCRT) could obtain better survival benefit for stage III or IV locally advanced nasopharyngeal carcinoma (LA-NPC). Only randomized controlled trials were incorporated. There were five treatments (CCRT, IC\u2009+\u2009CCRT, CCRT\u2009+\u2009AC, IC\u2009+\u2009RT and RT alone) recruited for analysis. Overall survival (OS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) with a hazard ratio (HR) were selected as endpoints. First of all, we performed a traditional meta-analysis and subsequently conducted network meta-analysis based on the Bayesian method. Totally, 15 studies, including 6182 patients, were incorporated for analysis. There was a statistically significant benefits in favor of IC\u2009+\u2009CCRT, compared with CCRT alone, for OS [HR\u2009=\u20090.75, 95% CI\u2009=\u20090.63–0.89], LRFS [HR\u2009=\u20090.70, 95% CI\u2009=\u20090.56–0.86], and DMFS [HR\u2009=\u20090.65, 95% CI\u2009=\u20090.54–0.78]. What s more, we did not observed any significant differences between CCRT\u2009+\u2009AC and CCRT alone for all the endpoints. Unsurprisingly, it was RT alone that demonstrate the poorest survival benefit. Strange to say, survival benefit, between IC\u2009+\u2009CCRT and IC\u2009+\u2009RT, or between IC\u2009+\u2009CCRT and CCRT\u2009+\u2009AC, did not significantly exist. Induction chemotherapy IC\u2009+\u2009CCRT provided better survival benefit than CCRT alone. CCRT\u2009+\u2009AC failed to increase survival benefit significantly compared to CCRT alone. More research about comparing IC\u2009+\u2009CCRT with IC\u2009+\u2009RT or CCRT\u2009+\u2009AC are needed.