Comparison Of Neoadjuvant Chemotherapy Followed By Concurrent Chemoradiotherapy Versus Concurrent Chemoradiotherapy Alone：a Meta-analysis

Objective To evaluate the efficacy and treatment toxicity ofneoadjuvant chemotherapy followed by concurrentchemoradiotherapy compared with concurrent chemoradiotherapyalone in the treatment of locoregionally advanced nasopharyngealcarcinoma.Methods The search strategy included Pubmed(1978-2013),Embase(1978-2013),the Cochrane Library, China National KnowledgeInternet Web (1978-2013), Vipbrowser Database(1978-2013) andWanfang Database(1978-2013). We also searched reference lists ofarticles as a complement. RCTs that compared neoadjuvantchemotherapy followed by concurrent chemoradiotherapy(IC+CCRT)with concurrent chemoradiotherapy(CCRT) alone in locoregionally advanced nasopharyngeal carcinoma were included. After studyselection, two reviewers assessed and extracted data independently.Meta-analysis was performed by using the RevMan5.1.0.software.Results Four studies were included in immediate result oftreatment evaluation: compared with CCRT, IC+CCRT got morecomplete response of cervical lymph nodes [OR=2.53,95%CI(1.44,4.44)],but had no significant difference between the twogroups in the CR of primary lesions (P＜0.05). Five studies wereincluded in the short-term efficacy evaluation: compared with theCCRT, IC+CCRT got more complete response of primary lesions andcervical lymph nodes [OR=1.07,95%CI(1.02,1.14)],[OR=1.11,95%CI(1.02,1.21)].Six studies were included in2years overall survival evaluation:there had no significant difference between the two groups (P＞0.05).There were no treatment-related deaths in both groups of six studies.Ten studies were included in treatment toxicity evaluation: Riskratios of [OR=1.57,95%CI(1.24,1.98)],[OR=1.34,95%CI(0.91,1.96)],[OR=1.13,95%CI(0.95,1.34)],[OR=0.99,95%CI(0.72,1.37)] wereobserved for leucopenia, dermatitis, mucositis, and gastrointestinaltoxicity during the treatment.Conclusion The neoadjuvant chemotherapy followed by concurrent chemoradiotherapy can improve the short-term efficacy oftreatment but increases the treatment toxicity in local advancednasopharyngeal carcinoma, and it cannot improve the immediateresult and2-year survival.