Comparison of Concurrent ChemoradiotherapyFollowed by Adjuvant Chemotherapy Versus ConcurrentChemoradiotherapy Alone in Locoregionally Advanced Nasopharyngeal Carcinoma: a Meta-analysis of 793 Patients from 5 Randomized Controlled Trials

Purpose: The main objective of the present study was to evaluate the efficacy and toxicity of concurrentchemoradiotherapy followed by adjuvant chemotherapy compared with concurrent chemoradiotherapy alonein the treatment of locoregionally advanced nasopharyngeal carcinoma.
Methods: The search strategy includedPubmed, Embase, the Cochrane Library, China National Knowledge Internet Web, Chinese Biomedical Databaseand Wanfang Database. We also searched reference lists of articles and the volumes of abstracts of scientificmeetings. Randomized controlled trials (RCTs) that compared concurrent chemoradiotherapy followed byadjuvant chemotherapy with concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngealcarcinoma were included. Meta-analysis was performed with RevMan 5.1.0. The Grading of RecommendationsAssessment, Development, and Evaluation system (GRADE) was used to rate the level of evidence.
Results: Fivestudies were included. Risk ratios of 1.02 (95%CI 0.89-1.15), 0.93 (95%CI 0.72-1.21), 1.07 (95%CI 0.87-1.32),0.95 (95%CI 0.80-1.13) were observed for 3 years overall survival, 5 years failure-free survival, 5 years locoregionalfailure-free survival and 5 years distant metastasis failure-free survival. There were no treatment-relateddeaths in both groups of five studies. Hematologic and gastrointestinal toxicity were the most significant forpatients during adjuvant chemotherapy. The level of evidence was low.
Conclusion: Compared with concurrentchemoradiotherapy alone, concurrent chemotherapy followed by adjuvant chemotherapy did not improveprognosis. More toxicity was found during adjuvant chemotherapy.