The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: A meta-analysis of the published literature
The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: A meta-analysis of the published literature
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DOI：
10.1200/jco.2004.10.074
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发表时间：
2004-11-15
影响因子：
45.3
通讯作者：
Slotman, BJ
中科院分区：
文献类型：
--
作者：
Langendijk, JA;Leemans, CR;Slotman, BJ
本荟萃分析的目的是确定在局部晚期鼻咽癌（NPC）治疗中，新辅助、同步和/或辅助化疗对总生存期（OS）、局部-区域复发（LRR）和远处转移（DM）发生率的额外价值。患者和方法为了入选，所有已发表的研究必须处理活检证实的鼻咽癌，并随机分配患者接受常规放疗（7周66至70 Gy）或放疗联合化疗。结果纳入10项随机临床研究，共纳入2450例患者。所有研究的合并死亡风险比（HR）为0.82 (95% Cl， 0.71至0.95;P = 0.01)，对应于5年后的绝对生存获益为4%。根据化疗的先后顺序定义了三类试验，包括新辅助化疗、至少伴随放化疗和辅助化疗。三者之间存在显著的交互项（P = 0.02）。合并化疗效果最大，总风险比为0.48 (95% Cl， 0.32至0.72)，相当于5年后生存获益20%。结论本研究结果提示，放疗加化疗可能是改善鼻咽癌OS最有效的方法。(C) 2004年由美国临床肿瘤学会出版。
Purpose The purpose of this meta-analysis was to determine the additional value of neoadjuvant, concurrent, and/or adjuvant chemotherapy to radiation in the treatment of locally advanced nasopharyngeal carcinoma (NPC) with regard to the overall survival (OS) and the incidence of local-regional recurrences (LRR) and distant metastases (DM).Patients and Methods To be eligible, full published studies had to deal with biopsy-proven NPC and have patients randomly assigned to receive conventional radiotherapy (66 to 70 Gy in 7 weeks) or radiotherapy combined with chemotherapy.Results Ten randomized clinical studies were identified, including 2,450 patients. The pooled hazard ratio (HR) of death for all studies was 0.82 (95% Cl, 0.71 to 0.95; P = .01) corresponding to an absolute survival benefit of 4% after 5 years. Three categories of trials were defined according to the sequence of chemotherapy, including neoadjuvant chemotherapy, at least concomitant chemoradiotherapy, and adjuvant chemotherapy. A significant interaction term (P = .02) was found among these three categories. The largest effect was found for concomitant chemotherapy, with a pooled HR of 0.48 (95% Cl, 0.32 to 0.72), which corresponds to a survival benefit of 20% after 5 years. Comparable results were found for the incidence of LRR and DM.Conclusion The results of this study indicate that concomitant chemotherapy in addition to radiation is probably the most effective way to improve OS in NPC. (C) 2004 by American Society of Clinical Oncology.