一项比较同步放化疗与单纯放疗治疗II期鼻咽癌的研究的系统评价和荟萃分析。

A Systematic Review and Meta-Analysis of Studies Comparing Concurrent Chemoradiotherapy With Radiotherapy Alone in the Treatment of Stage II Nasopharyngeal Carcinoma.

作者信息

Xu Yao-Can, Chen Kai-Hua, Liang Zhong-Guo, Zhu Xiao-Dong

机构信息

Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.

Department of Oncology, Affiliated Wu-Ming Hospital of Guangxi Medical University, Nanning, China.

出版信息

Front Oncol. 2022 Jul 12;12:843675. doi: 10.3389/fonc.2022.843675. eCollection 2022.

PURPOSE

The role of concurrent chemoradiotherapy (CCRT) in stage II nasopharyngeal carcinoma (NPC) is still controversial. Our objective is to evaluate the value of concurrent chemotherapy in stage II NPC receiving radiotherapy (RT).

METHODS

We searched the PubMed, Embase, and Scopus databases for studies comparing CCRT versus RT alone in stage II NPC with survival outcomes and toxicities, including locoregional recurrence-free survival (LRFS), metastasis-free survival (DMFS), progression-free survival (PFS), overall survival (OS), and grade 3-4 acute toxicities. The hazard ratios (HRs) of survival outcomes and risk ratios (RRs) of toxicities were extracted for meta-analysis. Subgroup analysis for stage N1 patients was performed to further explore whether these populations can earn benefits from concurrent chemotherapy.

RESULTS

Nine eligible studies with a total of 4,092 patients were included. CCRT was associated with a better OS (HR = 0.61, 95% CI 0.44-0.82), LRFS (HR = 0.62, 95% CI 0.50-0.78), and PFS (HR = 0.65, 95% CI 0.54-0.79), but with similar DMFS (HR = 0.81, 95% CI = 0.46-1.45) compared with two-dimensional RT (2DRT) alone. However, CCRT showed no survival benefit in terms of OS (HR = 0.84, 95% CI 0.62-1.15), LRFS (HR = 0.85, 95% CI 0.54-1.34), DMFS (HR = 0.96, 95% CI 0.60-1.54), and PFS (HR = 0.96, 95% CI 0.66-1.37) compared with intensity-modulated RT (IMRT) alone. Subgroup analyses indicated that CCRT had similar OS (HR = 1.04, 95% CI 0.37-2.96), LRFS (HR = 0.70, 95% CI 0.34-1.45), DMFS (HR = 1.03, 95% CI 0.53-2.00), and PFS (HR = 1.04, 95% CI 0.58-1.88) in the stage N1 populations. Meanwhile, compared to RT alone, CCRT significantly increased the incidence of grade 3-4 leukopenia (RR = 4.00, 95% CI 2.29-6.97), mucositis (RR = 1.43, 95% CI 1.16-1.77), and gastrointestinal reactions (RR = 8.76, 95% CI 2.63-29.12). No significant differences of grade 3-4 toxicity in thrombocytopenia (RR = 3.45, 95% CI 0.85-13.94) was found between the two groups.

CONCLUSION

For unselected patients with stage II NPC, CCRT was superior to 2DRT alone with better LRFS, PFS, and OS, while adding concurrent chemotherapy to IMRT did not significantly improve survival but exacerbated acute toxicities.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022318253.

目的

同步放化疗（CCRT）在II期鼻咽癌（NPC）中的作用仍存在争议。我们的目的是评估同步化疗在接受放疗（RT）的II期NPC中的价值。

方法

我们在PubMed、Embase和Scopus数据库中检索了比较II期NPC同步放化疗与单纯放疗的生存结局和毒性的研究，包括局部区域无复发生存率（LRFS）、无远处转移生存率（DMFS）、无进展生存率（PFS）、总生存率（OS）和3-4级急性毒性。提取生存结局的风险比（HRs）和毒性的风险比（RRs）进行荟萃分析。对N1期患者进行亚组分析，以进一步探讨这些人群是否能从同步化疗中获益。

结果

纳入9项符合条件的研究，共4092例患者。与单纯二维放疗（2DRT）相比，同步放化疗的总生存率（HR = 0.61，95%CI 0.44-0.82）、局部区域无复发生存率（HR = 0.62，95%CI 0.50-0.78）和无进展生存率（HR = 0.65，95%CI 0.54-0.79）更好，但远处转移无进展生存率相似（HR = 0.81，95%CI = 0.46-1.45）。然而，与单纯调强放疗（IMRT）相比，同步放化疗在总生存率（HR = 0.84，95%CI 0.62-1.15）、局部区域无复发生存率（HR = 0.85，95%CI 0.54-1.34）、远处转移无进展生存率（HR = 0.96，95%CI 0.60-1.54）和无进展生存率（HR = 0.96，95%CI 0.66-1.37）方面未显示出生存获益。亚组分析表明，在N1期人群中，同步放化疗的总生存率（HR = 1.04，95%CI 0.37-2.96）、局部区域无复发生存率（HR = 0.70，95%CI 0.34-1.45）、远处转移无进展生存率（HR = 1.03，95%CI 0.53-2.00）和无进展生存率（HR = 1.04，95%CI 0.58-1.88）相似。同时，与单纯放疗相比，同步放化疗显著增加了3-4级白细胞减少症（RR = 4.00，95%CI 2.29-6.97）、黏膜炎（RR = 1.43，95%CI 1.16-1.77）和胃肠道反应（RR = 8.76，95%CI 2.63-29.12）的发生率。两组在3-4级血小板减少症毒性方面未发现显著差异（RR = 3.45，95%CI 0.85-13.94）。