J Cancer 2018; 9(3):540-547. doi:10.7150/jca.22170

Research Paper

Optimal Treatment Modality for Locoregionally Advanced Nasopharyngeal Carcinoma: A Literature-Based Network Meta-Analysis

Bin-Bin Chen1*, Hao Peng1*, Ming-Zhu Liu1, Wei-Wei Xiao1, Jing-Jing Miao2, Chong Zhao2, Tai-Xiang Lu1, Ying Guo3, Fei Han1✉

1. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
2. Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
3. Department of Clinical Trial Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, People's Republic of China.
* Bin-Bin Chen and Hao Peng contributed equally to this work.

Abstract

Background: The standard care for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) has not been well-established: either induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) or CCRT followed by adjuvant chemotherapy (AC) may be the best treatments. We conducted a network meta-analysis to identity the optimal treatment for LA-NPC.

Methods: We searched electronic databases to identify eligible clinical trials involving patients with NPC randomly allocated to CCRT, CCRT + AC, IC + CCRT, or RT alone. End-points included overall survival (OS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS). Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were extracted. Network meta-analysis was performed using the frequentist approach for multiple treatment comparisons.

Results: In total, 11 studies involving 3165 patients were identified. IC + CCRT resulted in significantly better OS (HR, 0.65; 95% CI, 0.43-0.97) and DMFS (HR, 0.47; 95% CI, 0.31-0.73) than CCRT, without significantly increasing toxicities during CCRT. However, no significant differences were observed between IC + CCRT and CCRT + AC, or between CCRT and CCRT + AC for all the endpoints. As expected, RT alone was the least effective treatment. With regards to P-score, IC + CCRT ranked best for OS (95.3%) and DMFS (99.0%), while CCRT + AC ranked best for LRFS (79.1%); CCRT ranked third for all end-points.

Conclusions: IC + CCRT may be the most appropriate treatment for LA-NPC due to its significant OS and DMFS benefits, good compliance and acceptable toxicities.

Keywords: nasopharyngeal carcinoma, locoregionally advanced, concurrent chemoradiotherapy, induction chemotherapy, adjuvant chemotherapy, network meta-analysis.

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How to cite this article:
Chen BB, Peng H, Liu MZ, Xiao WW, Miao JJ, Zhao C, Lu TX, Guo Y, Han F. Optimal Treatment Modality for Locoregionally Advanced Nasopharyngeal Carcinoma: A Literature-Based Network Meta-Analysis. J Cancer 2018; 9(3):540-547. doi:10.7150/jca.22170. Available from http://www.jcancer.org/v09p0540.htm