Department of Radiotherapy, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Kunming, Yunnan, China.
Department of Head and Neck Surgery Section II, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Kunming, Yunnan, China.
Eur Arch Otorhinolaryngol. 2023 Jul;280(7):3097-3106. doi: 10.1007/s00405-023-07943-9. Epub 2023 Apr 20.
Concurrent chemoradiotherapy has long been a standardized therapy for localized advanced nasopharyngeal cancer. It is widely used in clinical applications. In contrast, NCCN guidelines highlight that the efficacy of concurrent chemoradiotherapy for stage II nasopharyngeal cancer in the new era of intensity-modulated radiotherapy has not been defined. Thus, we systematically reviewed the significance of concurrent chemoradiotherapy for stage II nasopharyngeal cancer.
We searched the relevant literature in PubMed, EMBASE, and Cochrane, extracting relevant data from the searched literature. The main items extracted were hazard ratios (HRs), risk ratios (RRs) and 95% confidence intervals (CIs). When the HR could not be extracted from the literature, we used Engauge Digitizer software for extraction. Data analysis was accomplished using the Review Manager 5.4 tool.
Our study included seven articles involving 1633 cases of stage II nasopharyngeal cancer. The survival outcomes were overall survival (OS) (HR = 1.03, 95% CI (0.71-1.49), P = 0.87), progression-free survival (PFS) (HR = 0.91, 95% CI (0.59-1.39), P = 0.66), distant metastasis-free survival (DMFS) (HR = 1.05, 95% CI (0.57-1.93), P = 0.87), local recurrence-free survival (LRFS) (HR = 0.87, 95% CI (0.41-1.84), P = 0.71, P > 0.05), and locoregional failure-free survival (LFFS) (HR = 1.18, 95% CI (0.52-2.70), P = 0.69).
In the era of intensity-modulated radiotherapy, concurrent chemoradiotherapy and radiotherapy alone have the same survival benefits, and concurrent chemoradiotherapy increases acute hematological toxicity. Subgroup analysis showed that for people with N1 nasopharyngeal cancer at risk of distant metastases, concurrent chemoradiotherapy and radiotherapy alone also had equal survival benefits.
同期放化疗长期以来一直是局部晚期鼻咽癌的标准化治疗方法。它在临床应用中得到了广泛应用。相比之下，NCCN 指南强调，在调强放疗新时代，同期放化疗治疗 II 期鼻咽癌的疗效尚未确定。因此，我们系统地回顾了同期放化疗治疗 II 期鼻咽癌的意义。
我们在 PubMed、EMBASE 和 Cochrane 中搜索相关文献，从检索文献中提取相关数据。提取的主要项目包括风险比（HRs）、风险比（RRs）和 95%置信区间（CIs）。当无法从文献中提取 HR 时，我们使用 Engauge Digitizer 软件进行提取。数据分析使用 Review Manager 5.4 工具完成。
我们的研究包括七篇文章，涉及 1633 例 II 期鼻咽癌患者。生存结果为总生存（OS）（HR=1.03，95%CI（0.71-1.49），P=0.87）、无进展生存（PFS）（HR=0.91，95%CI（0.59-1.39），P=0.66）、无远处转移生存（DMFS）（HR=1.05，95%CI（0.57-1.93），P=0.87）、局部无复发生存（LRFS）（HR=0.87，95%CI（0.41-1.84），P=0.71，P>0.05）和局部区域无失败生存（LFFS）（HR=1.18，95%CI（0.52-2.70），P=0.69）。
在调强放疗时代，同期放化疗和单纯放疗具有相同的生存获益，同期放化疗增加急性血液学毒性。亚组分析表明，对于有远处转移风险的 N1 期鼻咽癌患者，同期放化疗和单纯放疗也具有相同的生存获益。
