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J Clin Oncol. 2017 Feb 10;35(5):498-505. doi: 10.1200/JCO.2016.67.4119. Epub 2016 Dec 5.

What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis.

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Laureen Ribassin-Majed, Sophie Marguet, Jean Pierre Pignon, and Pierre Blanchard, Ligue Nationale Contre le Cancer meta-analysis platform, Gustave-Roussy, Université Paris-Saclay; Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France; Anne W.M. Lee and Wai Tong Ng, Pamela Youde Nethersole Eastern Hospital; Anthony T.C. Chan, The Chinese University of Hong Kong; Daniel T.T. Chua, Hong Kong Sanatorium & Hospital; Dora L.W. Kwong, Queen Mary Hospital; Yuk Tung, Tuen Mun Hospital, Hong Kong; Jun Ma, Pei-Yu Huang, Yong Chen, and Hai-Qiang Mai, Sun Yat-sen University Cancer Center, Guangzhou; Guopei Zhu, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Shie-Lee Cheah, National Cancer Centre, Singapore, Singapore; James Moon, SWOG Statistical Center, Seattle, WA; Kwan-Hwa Chi, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; George Fountzilas, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece; and Jean Bourhis, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.


Purpose The role of adjuvant chemotherapy (AC) or induction chemotherapy (IC) in the treatment of locally advanced nasopharyngeal carcinoma is controversial. The individual patient data from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma database were used to compare all available treatments. Methods All randomized trials of radiotherapy (RT) with or without chemotherapy in nonmetastatic nasopharyngeal carcinoma were considered. Overall, 20 trials and 5,144 patients were included. Treatments were grouped into seven categories: RT alone (RT), IC followed by RT (IC-RT), RT followed by AC (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concomitant chemoradiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). P-score was used to rank the treatments. Fixed- and random-effects frequentist network meta-analysis models were applied. Results The three treatments with the highest probability of benefit on overall survival (OS) were CRT-AC, followed by CRT and IC-CRT, with respective hazard ratios (HRs [95% CIs]) compared with RT alone of 0.65 (0.56 to 0.75), 0.77 (0.64 to 0.92), and 0.81 (0.63 to 1.04). HRs (95% CIs) of CRT-AC compared with CRT for OS, progression-free survival (PFS), locoregional control, and distant control (DC) were, respectively, 0.85 (0.68 to 1.05), 0.81 (0.66 to 0.98), 0.70 (0.48 to 1.02), and 0.87 (0.61 to 1.25). IC-CRT ranked second for PFS and the best for DC. CRT never ranked first. HRs of CRT compared with IC-CRT for OS, PFS, locoregional control, and DC were, respectively, 0.95 (0.72 to 1.25), 1.13 (0.88 to 1.46), 1.05 (0.70 to 1.59), and 1.55 (0.94 to 2.56). Regimens with more chemotherapy were associated with increased risk of acute toxicity. Conclusion The addition of AC to CRT achieved the highest survival benefit and consistent improvement for all end points. The addition of IC to CRT achieved the highest effect on DC.

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