The efficacy and safety of induction chemotherapy combined with concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in nasopharyngeal carcinoma patients: a systematic review and meta-analysis

BackgroundInduction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) has been recommended as the first-line therapy for locoregional nasopharyngeal carcinoma (NPC). Due to the different chemotherapeutic drugs used in the IC and CCRT, the results remain controversial.MethodsPubMed, EMBASE, Web of Science, and Cochrane Library databases were systematically retrieved to search potentially eligible clinical trials up to Sep 11, 2019. Eligible studies were registered and prospective randomized controlled clinical trials.ResultsFrom 526 records, nine articles including seven randomized controlled clinical trials were eligible, with a total of 2311 locoregional advanced NPC patients. IC+CCRT had significantly lower risks of death (3-year hazard ratio [HR]: 0.70, 95% confidence interval [CI] 0.55-0.89, p=0.003; 5-year HR: 0.77, 95% CI 0.62-0.94, p=0.01), disease progression (3-year HR: 0.67, 95% CI 0.55-0.80, p<0.001; 5-year HR: 0.70, 95% CI 0.58-0.83, p<0.0001), distant metastasis (3-year HR: 0.58, 95% CI 0.45-0.74, p<0.0001; 5-year HR: 0.69, 95% CI 0.55-0.87, p=0.001) and locoregional relapse (3-year HR: 0.69, 95% CI 0.50-0.95, p=0.02; 5-year HR: 0.66, 95% CI 0.51-0.86, p=0.002) than CCRT. Compared with CCRT, IC+CCRT showed higher relative risks of grade 3 or more neutropenia, thrombocytopenia, nausea, vomiting and hepatotoxicity throughout the course of treatment, and higher relative risks of grade<greater than or equal to>3 thrombocytopenia and vomiting during CCRT.ConclusionIC combined with CCRT significantly improved the survival in locoregional advanced NPC patients. Moreover, toxicities were well tolerated during IC and CCRT. Further clinical trials are warranted to confirm the optimal induction chemotherapeutic regimen in the future.