AUTHOR=Yang Jie , Liang Zhong-Guo , Jiang Yu-Ting , Chen Kai-Hua , Li Ling , Qu Song , Zhu Xiao-Dong 

TITLE=Efficacy and Safety of Concurrent Chemoradiotherapy Combined With Induction Chemotherapy or Adjuvant Chemotherapy in Patients With Stage II–IVA Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis and Meta-Analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.778836

DOI=10.3389/fonc.2021.778836

ISSN=2234-943X

ABSTRACT=Purpose: To evaluate the efficacy and safety of induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) versus CCRT combined with adjuvant chemotherapy (AC) in patients with stage Ⅱ-Ⅳ nasopharyngeal carcinoma (NPC), we conducted a retrospective study and a meta-analysis combining the results of our studies.
Patients and methods: We used the propensity score-matched (PSM) to balance variables. A total of 168 patients were chosen by one-to-two PSM, including 101 patients with IC+CCRT and 67 cases with CCRT+AC. We used the Kaplan-Meier curve to compare survival outcomes, and also used Cox regression analysis to determine independent prognostic factors. For meta-analysis, we determined the related studies by searching the Pubmed database. We used STATA v12 software to perform meta-analysis of the extracted data, and calculate pooled hazard ratios, 95% confidence intervals of survival outcomes, and risk ratios for the toxicities.
Results: In this retrospective study, there was no significant difference in 5-year overall survival (76.9% vs 79.0%, p=0.966), progression-free survival (70.5% vs 68.5%, p=0.378), distant metastasis-free survival (80.5% vs 74.2 %, p=0.140) and locoregional relapse-free survival (91.5 % vs 91.8 %, p=0.894) among patients with NPC with IC+CCRT versus CCRT+AC after PSM. For meta-analysis, 6 articles (including our study) reported 1052 cases of IC + CCRT and 883 cases of CCRT + AC were included in meta-analysis. There was no difference of OS (pooled HR = 0.90, 95% CI=0.63-1.28, P = 0.555), PFS (pooled HR = 1.07, 95% CI: 0.86–1.32, P = 0.539), DMFS (95% CI: 0.76–1.25, P = 0.861) and LRRFS (pooled HR = 1.06, 95% CI: 0.76–1.48, P = 0.724).
Conclusion: The efficacy of IC+CCRT and CCRT+AC was comparable in patients with stage Ⅱ-Ⅳ NPC. In terms of compliance and acute adverse reactions, IC+CCRT may be a potential therapeutic strategy.