关键词: 新辅助化疗, 同期放化疗, 鼻咽癌, Meta分析

Abstract:

Objective    To evaluate the efficacy and treatment toxicity of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy compared with concurrent chemoradiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma. Methods    The search strategy included Pubmed(1978-2013), Embase(1978-2013),the Cochrane Library, China National Knowledge Internet Web (1978-2013), Vipbrowser Database(1978-2013) and Wanfang Database(1978-2013). We also searched reference lists of articles as a complement. RCTs that compared neoadjuvant chemotherapy followed by concurrent chemoradiotherapy(IC+CCRT) with concurrent chemoradiotherapy(CCRT) alone in locoregionally advanced nasopharyngeal carcinoma were included. After study selection, two reviewers assessed and extracted data independently. Meta-analysis was performed by using the RevMan 5.1.0.software. Results    Four studies were included in immediate result of treatment evaluation: compared with CCRT, IC+CCRT got more complete response of cervical lymph nodes［OR=2.53, 95%CI(1.44,4.44)］, but had no significant difference between the two groups in the CR of primary lesions (P＜0.05). Five studies were included in the short-term efficacy evaluation: compared with the CCRT, IC+CCRT got more complete response of primary lesions and cervical lymph nodes ［OR=1.07, 95%CI(1.02,1.14)］, ［OR=1.11, 95%CI(1.02,1.21)］. Six studies were included in 2 years overall survival evaluation: there had no significant difference between the two groups (P＞0.05). There were no treatment-related deaths in both groups of six studies. Ten studies were included in treatment toxicity evaluation: Risk ratios of ［OR=1.57, 95%CI(1.24,1.98)］, ［OR=1.34, 95%CI(0.91,1.96)］, ［OR=1.13, 95%CI(0.95,1.34)］, ［OR=0.99, 95%CI(0.72,1.37)］. were observed for leucopenia, dermatitis, mucositis, and gastrointestinal toxicity during the treatment. Conclusion    The neoadjuvant chemotherapy followed by concurrent chemoradiotherapy can improve the shortterm efficacy of treatment but increases the treatment toxicity in local advanced nasopharyngeal carcinoma, and it cannot improve the immediate result and 2-year survival.

Key words: Nasopharyngeal carcinoma, Induced chemotherapy, Neoadjuvant chemotherapy, Chemoradiotherapy