ENT and HN Surgery Department, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
ENT & HN Surgery Department, Shanglin County People's Hospital, Nanning, Guangxi, China.
Medicine (Baltimore). 2022 Dec 30;101(52):e31842. doi: 10.1097/MD.0000000000031842.
Cisplatin-based concurrent chemoradiotherapy is a standard of care for locally advanced nasopharyngeal carcinoma (NPC), and weekly and triweekly cisplatin are both alternative regimens based on the results of squamous cell carcinoma of the head and neck. However, there is a lack of direct evidence on the efficacy and safety of weekly versus triweekly cisplatin concurrent with radiotherapy in NPC alone. This meta-analysis aimed to identify which regimen is more superior between weekly and triweekly cisplatin in patients with NPC treated with concurrent chemoradiotherapy.
The PubMed, Embase, and Cochrane Library were searched for eligible literatures. Clinical outcome measures including 1-year overall survival (OS), 3-year OS, 5-year OS, 5-year loco-regional failure-free survival, 5-year distant metastasis-free survial and the most common 3 grade or higher acute toxicities (hematological toxicity, mucositis and nausea and vomiting) were analyzed by RevMan 5.4 software; significance level was 0.05.
Seven clinical controlled studies with 1795 patients were included in the meta-analysis. There were no significant differences between weekly and triweekly cisplatin in 1-year OS, 3-year OS, 5-year OS, 5-year loco-regional failure-free survival, and 5-year distant metastasis-free survial) (all P > .05). Grade 3 or higher mucositis and nausea and vomiting showed similar between the 2 arms. However, grade 3 or higher hematological toxicity of weekly cisplatin was significantly higher than that of triweekly cisplatin (1.55; 95% CI, 1.22-1.98, P = .0004).
Weekly cisplatin resulted in similar survival benifit as triweekly cisplatin, but with higher hematological toxicity.
顺铂为基础的同期放化疗是局部晚期鼻咽癌（NPC）的标准治疗方法，基于头颈部鳞状细胞癌的结果，每周和每三周给予顺铂都是替代方案。然而，单独 NPC 患者同期放化疗中每周与每三周给予顺铂的疗效和安全性方面缺乏直接证据。本荟萃分析旨在确定在 NPC 患者中，每周与每三周给予顺铂同期放化疗方案中哪一种方案更优越。
检索 PubMed、Embase 和 Cochrane Library 以获取合格文献。采用 RevMan 5.4 软件分析临床结局指标，包括 1 年总生存率（OS）、3 年 OS、5 年 OS、5 年局部区域无失败生存率、5 年远处无转移生存率和最常见的 3 级或更高级别的急性毒性（血液学毒性、黏膜炎和恶心呕吐）；检验水准为 0.05。
纳入了 7 项包含 1795 例患者的临床对照研究进行荟萃分析。每周和每三周给予顺铂在 1 年 OS、3 年 OS、5 年 OS、5 年局部区域无失败生存率和 5 年远处无转移生存率方面均无统计学差异（均 P＞0.05）。2 组间 3 级或更高等级黏膜炎和恶心呕吐发生率相似。然而，每周给予顺铂的 3 级或更高等级血液学毒性明显高于每三周给予顺铂（1.55；95%CI，1.22-1.98，P=0.0004）。
每周给予顺铂与每三周给予顺铂相比具有相似的生存获益，但血液学毒性更高。
