Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): To determine the benefits of adding induction chemotherapy (IC) to concurrent chemoradiotherapy (CCRT) for treatment of locally advanced nasopharyngeal carcinoma (LANPC).
Materials/Methods: We searched various biomedical databases for randomized trials (RCTs) comparing IC plus CCRT versus (vs) CCRT alone in LANPC. The four outcomes of interests were overall survival (OS), progression-free survival (PFS), locoregional progression-free survival (LRPFS) and distant metastasis-free survival (DMFS). We assessed the quality of the summarized evidence using the GRADE approach. We performed the meta-analysis with a random effects model. We used meta-regression to determine if there is an effect modification on the association between IC and the four outcomes of interest by pre-specified factors (age, gender, T4 stage of disease, N2 or N3 stage of disease, region where the trial was conducted (Asia vs non-Asia), use of docetaxel, cisplatin and fluorouracil and use of intensity modulated radiotherapy).
Results: We found six eligible randomized trials with no significant methodological bias including 1415 patients. Adding induction chemotherapy improved OS (hazard ratio (HR) 0.771, 95% confidence interval (CI) 0.601-0.988, P-value (P) = 0.037, I-squared (I2) = 3.3%), PFS (HR 0.688, 95% CI 0.567-0.836, P < 0.0001, I2= 0%), LRPFS (HR 0.656, 95% CI 0.450-0.956, P = 0.028, I2 = 0%) and DMFS (HR 0.627, 95% CI 0.475-0.829, P = 0.001, I2 = 0%). The quality of summarized evidence was high. Meta-regression did not demonstrate any effect modification on the association between IC and the four outcomes of interest by the prespecified factors.
Conclusion: Adding IC to CCRT significantly improved overall survival and reduced both locoregional and distant disease recurrence for LANPC. We did not identify any factors that has an effect modification on the association between IC and the outcomes of interest.
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