Third Military Medical University, Chongqing, China.
Radiother Oncol. 2012 Sep;104(3):279-85. doi: 10.1016/j.radonc.2012.08.022. Epub 2012 Sep 13.
We performed a meta-analysis of randomized controlled trials (RCTs) to determine the overall risk of treatment-related death associated with additional cisplatin-based chemotherapy in patients with nasopharyngeal carcinoma treated with standard radiotherapy.
Eligible studies included RCTs in which cisplatin-based chemotherapy in combination with radiotherapy was compared with radiotherapy alone. Statistical analyses were conducted to calculate the summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) using fixed- or random-effects models based on the heterogeneity of included studies.
A total of 2829 patients from 13 RCTs were included in this study. The overall incidence for treatment-related death in chemoradiotherapy and radiotherapy treated patients was 1.7% and 0.8%. Compared to radiotherapy alone, radiotherapy plus cisplatin-based chemotherapy significantly increased the risk of treatment-related mortality. On subgroup analyses, no difference was found in treatment-related mortality between different timings of chemotherapy and chemotherapeutic agents. Adding cisplatin-based chemotherapy was associated with higher incidences of severe acute toxicity.
Cisplatin-based chemotherapy plus radiotherapy increased the risk of treatment-related death and severe acute toxicity, compared with radiotherapy alone. Better management of treatment toxicity might improve the therapeutic gain in patients with nasopharyngeal carcinoma.
我们进行了一项荟萃分析，纳入了随机对照试验（RCT），以确定标准放疗联合顺铂为基础的化疗治疗鼻咽癌患者的治疗相关死亡率的总体风险。
纳入研究为顺铂为基础的化疗联合放疗与单纯放疗比较的 RCT。根据纳入研究的异质性，采用固定或随机效应模型计算汇总发生率、相对风险（RR）和 95%置信区间（CI）。
共有来自 13 项 RCT 的 2829 名患者纳入本研究。接受放化疗和单纯放疗的患者的治疗相关死亡发生率分别为 1.7%和 0.8%。与单纯放疗相比，顺铂为基础的化疗联合放疗显著增加了治疗相关死亡的风险。亚组分析显示，不同化疗时间和化疗药物的治疗相关死亡率无差异。基于顺铂的化疗联合治疗与严重急性毒性的发生率增加相关。
与单纯放疗相比，顺铂为基础的化疗联合放疗增加了治疗相关死亡和严重急性毒性的风险。更好地管理治疗毒性可能会提高鼻咽癌患者的治疗收益。
