Langendijk J A, Leemans C R, Buter J, Berkhof J, Slotman B J
Department of Radiation Oncology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
J Clin Oncol. 2004 Nov 15;22(22):4604-12. doi: 10.1200/JCO.2004.10.074.
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).
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.
Ten randomized clinical studies were identified, including 2,450 patients. The pooled hazard ratio (HR) of death for all studies was 0.82 (95% CI, 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% CI, 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.
The results of this study indicate that concomitant chemotherapy in addition to radiation is probably the most effective way to improve OS in NPC.
本荟萃分析的目的是确定新辅助化疗、同步化疗和/或辅助化疗联合放疗在治疗局部晚期鼻咽癌（NPC）时对总生存期（OS）、局部区域复发率（LRR）和远处转移率（DM）的附加价值。
符合条件的已发表完整研究必须涉及经活检证实的鼻咽癌患者，且患者被随机分配接受常规放疗（7周内66至70 Gy）或放疗联合化疗。
共纳入10项随机临床研究，包括2450例患者。所有研究的合并死亡风险比（HR）为0.82（95%可信区间，0.71至0.95；P = 0.01），相当于5年后绝对生存获益4%。根据化疗顺序定义了三类试验，包括新辅助化疗、至少同步放化疗和辅助化疗。在这三类试验中发现了显著的交互作用项（P = 0.02）。同步化疗的效果最为显著，合并HR为0.48（95%可信区间，0.32至0.72），相当于5年后生存获益20%。在LRR和DM的发生率方面也发现了类似结果。
本研究结果表明，放疗联合同步化疗可能是改善鼻咽癌OS的最有效方法。
