Zeng H, Wang H, Liu S, Xu X
Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China.
Department of Oncology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China.
Clin Oncol (R Coll Radiol). 2025 Feb;38:103652. doi: 10.1016/j.clon.2024.10.004. Epub 2024 Oct 5.
The efficacy of concurrent chemoradiotherapy (CCRT) for Stage II and T3N0 nasopharyngeal carcinoma (NPC), particularly during the shift from two-dimensional conventional radiotherapy (2DCRT) to intensity-modulated radiotherapy (IMRT) is debated.Therefore this study aims to systematically evaluate and meta-analyze survival benefits of CCRT versus radiotherapy alone for Stage II and T3N0 NPC, stratified by radiotherapy techniques.
As of April 1, 2024, we conducted an exhaustive literature search across databases such as PubMed, Embase, Cochrane Library, and Web of Science, with the aim of identifying and screening studies that compare the efficacy of CCRT versus radiotherapy alone in the treatment of Stage II and T3N0 NPC.
A total of 10 studies encompassing 5015 patients were included in this comprehensive analysis. The findings indicate that, apart from progression-free survival (PFS), CCRT did not improve survival outcomes, including overall survival (OS), distant metastasis-free survival (DMFS), local recurrence-free survival (LRRFS), and failure-free survival (FFS), with all P values exceeding 0.05. Concurrently, the incidence of grade ≥3 adverse events associated with CCRT was significantly elevated (odds ratio [OR] = 3.77, 95% confidence interval [CI] = 2.75-5.15, P < 0.0001). Subgroup analysis revealed that, compared with RT, the combination of 2DCRT with concurrent chemotherapy significantly improved OS (hazard ratio [HR] = 0.57, 95% CI = 0.46-0.71, P < 0.00001), PFS (HR = 0.65, 95% CI=0.53-0.78, P < 0.00001), DMFS (HR = 0.54, 95% CI = 0.37-0.79, P = 0.002), and LRRFS (HR = 0.63, 95% CI = 0.49-0.82, P = 0.0005). In contrast, the combination of IMRT with concurrent chemotherapy failed to demonstrate improvements in OS, PFS, DMFS, or LRRFS, with all P values exceeding 0.05.
In contrast with RT, CCRT did not enhance survival in stage II and T3N0 NPC patients, yet caused more adverse reactions. 2DCRT combined with concurrent chemotherapy significantly improved OS, PFS, DMFS, and LRRFS, while IMRT with concurrent chemotherapy showed no clinical benefits.
对于II期和T3N0期鼻咽癌（NPC），同步放化疗（CCRT）的疗效，尤其是在从二维常规放疗（2DCRT）向调强放疗（IMRT）转变过程中的疗效存在争议。因此，本研究旨在系统评估并荟萃分析CCRT与单纯放疗相比，在II期和T3N0期NPC患者中的生存获益，并按放疗技术进行分层。
截至2024年4月1日，我们在PubMed、Embase、Cochrane图书馆和Web of Science等数据库中进行了全面的文献检索，目的是识别和筛选比较CCRT与单纯放疗治疗II期和T3N0期NPC疗效的研究。
本综合分析共纳入10项研究，涉及5015例患者。研究结果表明，除无进展生存期（PFS）外，CCRT并未改善生存结局，包括总生存期（OS）、无远处转移生存期（DMFS）、无局部复发生存期（LRRFS）和无失败生存期（FFS），所有P值均超过0.05。同时，与CCRT相关的≥3级不良事件发生率显著升高（比值比[OR]=3.77，95%置信区间[CI]=2.75 - 5.15，P<0.0001）。亚组分析显示，与单纯放疗相比，2DCRT联合同步化疗显著改善了OS（风险比[HR]=0.57，95%CI=0.46 - 0.71，P<0.00001）、PFS（HR=0.65，95%CI=0.53 - 0.78，P<0.00001）、DMFS（HR=0.54，95%CI=0.37 - 0.79，P=0.002）和LRRFS（HR=0.63，95%CI=0.49 - 0.82，P=0.0005）。相比之下，IMRT联合同步化疗在OS、PFS、DMFS或LRRFS方面未显示出改善，所有P值均超过0.05。
与单纯放疗相比，CCRT并未提高II期和T3N0期NPC患者的生存率，但会导致更多不良反应。2DCRT联合同步化疗显著改善了OS、PFS、DMFS和LRRFS，而IMRT联合同步化疗未显示出临床获益。
