Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2025, Vol. 39 ›› Issue (4): 31-41.doi: 10.6040/j.issn.1673-3770.0.2025.123

• Clinical Research • Previous Articles     Next Articles

Efficacy analysis of concurrent chemoradiotherapy with high and low cumulative cisplatin doses in the treatment of nasopharyngeal carcinoma

SUN Chunxiao1, WANG Wenqing2, YUE Tian1, LIU Jisheng1   

  1. 1. Department of Otorhinolaryngology, the First Affiliated Hospital of Soochow University, Suzhou Clinical Medical Center for Otohinolaryngology Head and Neck Surgery, Suzhou 215006, Jiangsu, China2. Department of Otorhinolaryngology, Changshu Second People's Hospital, Changshu 215500, Jiangsu, China
  • Online:2025-07-20 Published:2025-08-11

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Abstract: Objective The objective of this study is to conduct a quantitative comparison of the survival efficacy and adverse reactions between the cumulative cisplatin dose(CCD)≤200 mg/m2 cohort and the CCD>200 mg/m2 cohort through meta-analysis, providing an evidence-based rationale for individualised treatment. Methods A systematic search was conducted across PubMed, Embase, Web of Science, Cochrane Library and Chinese Biomedical Literature Database up to February 2025. The observational indexes included 5-year overall survival(5-OS), 5-year progression free survival(5-PFS), 5-year distant metastasis free survival(5-DMFS)and adverse events(AEs). RevMan 5.4 software was utilized to perform the meta-analysis. The heterogeneity among the included studies was assessed using I2 values. Furthermore, funnel plots were used to evaluate potential publication bias. Results Nine cohort studies were included. Data covering 7,418 patients diagnosed with nasopharyngeal cancer were collected, includeding 5,899 cases in the CCD≤200 mg/m2 cohort and 1,519 cases in the CCD >200 mg/m2 cohort. In comparison with the cohort of CCD >200 mg/m2, the CCD≤200 mg/m2 cohort did not exhibit a statistically significant reduction in 5-OS(RR=0.98,95%CI:0.96-1.00), 5-PFS(RR=0.96,95%CI:0.91-1.01)and 5-DMFS(RR=0.97,95%CI:0.93-1.01). Further subgroup analyses of 5-OS and 5-DMFS yielded consistent results. In relation to AEs, the CCD≤200 mg/m2 cohort demonstrated a conspicuously diminished occurrence of acute toxic reactions compared to the CCD >200 mg/m2 cohort. This was observed in grade 1-4 leukopenia(RR=0.91,95%CI:0.86-0.97),grade 1-4 ALT elevation(RR=0.69,95%CI:0.58-0.82)and any grade of creatinine elevation(grade 1-4: RR=0.73,95%CI:0.60-0.88; grade 3-4: RR=0.20,95%CI:0.04-0.89). With regard to late toxicities, both grade 1-4 hearing impairment(RR=0.81,95%CI:0.70-0.94)and any grade of dermal fibrosis(grade 1-4:RR=0.77,95%CI:0.64-0.92; grade 3-4: RR=0.43,95%CI:0.21-0.89)exhibited a substantial reduction within the CCD≤200 mg/m2 cohort. However, no statistically significant differences were found between the two cohorts in other AEs, including grade 3-4 leukopenia, grade 3-4 ALT increase, grade 3-4 hearing impairment and any grade of anemia, thrombocytopenia, neutrophilic leukopenia, AST increase, dry mouth, clenching of teeth or cranial neuropathy. Conclusion This study indicates that in the treatment of nasopharyngeal carcinoma with concurrent chemoradiotherapy(CCRT), CCD≤200 mg/m2 may achieve therapeutic efficacy comparable to that of CCD>200 mg/m2, and may potentially reduce the risk of AEs.

Key words: Nasopharyngeal Carcinoma, Cisplatin, Chemoradiotherapy, Comparative Effectiveness Research, Meta-Analysis

CLC Number: 

  • R766.3
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