Significant benefits of adding neoadjuvant chemotherapy before concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized controlled trials

// Mengmeng Wang 1 , Huimin Tian 1 , Gang Li 2 , Tingwen Ge 1 , Yudi Liu 1 , Jiuwei Cui 1 , Fujun Han 1 1 Cancer Center, The First Hospital of Jilin University, Changchun, China 2 Department of Thyroid and Breast Surgery, No.458 Hospital of People’s Liberation Army, Guangzhou, China Correspondence to: Fujun Han, email: fujun_han@aliyun.com Keywords: adjuvant chemotherapy, concurrent chemoradiotherapy, meta-analysis, nasopharyngeal carcinoma, neoadjuvant chemotherapy Received: January 21, 2016     Accepted: May 30, 2016     Published: June 23, 2016 ABSTRACT Purpose: We did a meta-analysis to compare the efficacy and safety of neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) versus CCRT with or without adjuvant chemotherapy (AC) for patients with locoregionally advanced nasopharyngeal carcinoma based on randomized controlled trials. Methods: We searched PubMed, Embase, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure, and meeting proceedings of major relevant conferences to identify published and unpublished randomized controlled trials. Progression-free survival (PFS) was the primary endpoint. Results: This meta-analysis included 9 randomized clinical trials with 2215 patients. NACT followed by CCRT significantly improved PFS (HR=0.68, 95% CI 0.56 – 0.81, P < 0.001) compared versus CCRT with or without AC, and no heterogeneity was observed (I 2 = 0.0%, P = 0.975). NACT was associated with a significant improvement in overall survival (HR = 0.64, 95% CI 0.49 – 0.84, P = 0.001; I 2 = 0.0%, P = 0.467) and distant failure-free survival (HR = 0.72, 95% CI 0.53 – 0.97, P = 0.031; I 2 = 0.0%, P = 0.744). No significant benefit was shown by NACT for locoregional control. NACT with CCRT increased risks of grade 3 – 4 anemia, thrombocytopenia, leukopenia, and fatigue, compared versus CCRT with or without AC. Conclusions: Our meta-analysis confirmed that the addition of NACT to CCRT significantly improved PFS and OS versus CCRT with or without AC for locoregionally advanced nasopharyngeal carcinoma. These results may alter the standard of care - CCRT with or without AC, for locoregionally advanced nasopharyngeal carcinoma.