Induction Chemotherapy Followed by Concurrent Chemoradiotherapy Versus Concurrent Chemoradiotherapy with or without Adjuvant Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma: Meta-analysis of 1,096Patients from 11 Randomized Controlle

Purpose: To evaluate the efficacy and toxicity of induction chemotherapy followed by concurrentchemoradiotherapy (the treatment group) versus concurrent chemoradiotherapy with or without adjuvantchemotherapy (the control group) for locoregionally advanced nasopharyngeal carcinoma.
Methods: The searchstrategy included Pubmed, Embase, the Cochrane Library, China National Knowledge Internet Web, ChineseBiomedical Database and Wanfang Database. We also searched reference lists of articles and the volumes ofabstracts of scientific meetings. All randomized controlled trials were included for a meta-analysis performedwith RevMan 5.1.0. The Grading of Recommendations Assessment, Development, and Evaluation system(GRADE) was used to rate the level of evidence.
Results: Eleven studies were included. Risk ratios of 0.99(95%CI 0.72-1.36), 0.37 (95%CI 0.20-0.69), 1.08 (95%CI 0.84-1.38), 0.98 (95%CI 0.75-1.27) were observed for3 years overall survival, 3 years progression-free survival, 2 years loco-regional failure-free survival and 2 yearsdistant metastasis failure-free survival. There were no treatment-related deaths in either group in the 11 studies.Risk ratios of 1.90 (95%CI 1.24-2.92), 2.67 (95%CI 0.64-11.1), 1.04 (95%CI 0.79-1.37), 0.98 (95%CI 0.27-3.52)were found for grade 3-4 leukopenia, grade 3-4 thrombocytopenia, grade 3-4 mucous membrane, and grade3-4 hepatic hematologic and gastrointestinal toxicity, the most significant toxicities for patients.
Conclusion:Compared with the control group, induction chemotherapy followed by concurrent chemoradiotherapy was welltolerated but could not significantly improve prognosis in terms of overall survival, loco-regional failure-freesurvival or distant metastasis failure-free survival.