Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma - Results of a meta-analysis of 1,528 patients from six randomized trials
Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal carcinoma - Results of a meta-analysis of 1,528 patients from six randomized trials
复制标题
DOI：
10.1097/00000421-200206000-00002
复制
发表时间：
2002-06-01
影响因子：
2.6
通讯作者：
Kupelnick, B
中科院分区：
文献类型：
--
作者：
Huncharek, M;Kupelnick, B
目前尚不清楚在标准放射治疗的基础上增加化疗是否能改善局部区域晚期鼻咽癌患者的临床预后。进行了一项荟萃分析，以评估在该临床环境中化疗与外束放射治疗相结合的影响。使用先前描述的方法，制定了一项方案，概述了一项荟萃分析，研究了局部区域晚期鼻咽癌中放化疗与单独放化疗（对照ann）的影响。感兴趣的结果是无病/无进展和总生存期。前瞻性地定义文献检索技术、研究纳入标准和统计程序。采用固定效应模型（Peto）对所有可用的随机对照试验数据进行汇总。结果表示为总结相对风险。对异质性进行了统计检验。如果统计异质性被证实，进行敏感性分析以评估纳入研究中可能的异质性来源。文献检索确定了六项随机对照试验，招募了1500多名患者。所有试验都将标准根治外束放射治疗（对照）与辅助、新辅助或与放射同时进行的放射加化疗进行了比较。将所有六项以无病/无进展生存期为终点的研究进行汇总，结果表明，在放疗基础上增加化疗可使治疗后2年无病/无进展生存期提高37%，3年提高40%，4年提高34%。同样，在治疗方案中增加化疗后2年总生存的总相对风险为0.80(0.63-1.02)，反映了2年生存增加了20%。这一发现在临床上无统计学意义。3年和4年生存率分别提高19%和21%，4年生存率数据具有统计学意义。局部晚期鼻咽癌在标准根治性放射治疗的基础上增加化疗，治疗后2至4年的无病/无进展和总生存率均提高19%至40%，具体取决于感兴趣的终点。未来的试验需要证实这些结果，并确定在这种情况下化疗与放疗结合的最有效方案。
It is currently unclear whether the addition of chemotherapy to standard radiation therapy improves clinical outcome in patients with locoregionally advanced nasopharyngeal cancer. A meta-analysis was performed to evaluate the impact of integrating chemotherapy with external beam radiation therapy in this clinical setting. Using previously described methods, a protocol was developed outlining a meta-analysis examining the influence of chemoradiation versus radiation alone (control ann) in locoregionally advanced nasopharyngeal carcinoma. The outcomes of interest were disease-free/progression-free and overall survival. Literature search techniques, study inclusion criteria, and statistical procedures were prospectively defined. Data from all available randomized controlled trials was pooled using a fixed effects model (Peto). Results were expressed as summary relative risks. Statistical tests for heteroaeneity were performed. If statistical heterogeneity was demonstrated, sensitivity analyses were performed to evaluate possible sources of heterogeneity across the included studies. The literature search identified six randomized controlled trials enrolling more than 1,500 patients. All trials compared standard radical external beam radiation therapy (control ann) with radiation plus chemotherapy delivered either adjuvantly, neoadjuvantly, or concurrently with radiation. Pooling all six studies using disease-free/progression-free survival as the endpoint demonstrated that the addition of chemotherapy to radiation therapy increased disease-free/progression-free survival by 37% at 2 years, 40% at 3 years, and 34% at 4 years after treatment. Likewise, the summary relative risk for overall survival at 2 years after treatment with the addition of chemotherapy to the treatment regimen was 0.80 (0.63-1.02), reflecting a 20% increase in 2-year survival. This finding was marclinally non-statistically significant. Three- and 4-year survival was increased by 19% and 21%, respectively, with the data for 4-year survival being statistically significant. The addition of chemotherapy to standard radical radiation therapy for locoregionally advanced nasopharyngeal cancer increases both disease-free/progression-free and overall survival by 19 to 40% at 2 to 4 years after treatment, depending on the endpoint of interest. Future trials are needed to confirm these results and determine the most effective regimen for integrating chemotherapy with radiation therapy in this setting.