Concurrent Chemoradiotherapy Plus Adjuvant Chemotherapy Compared With Concurrent Chemoradiotherapy Alone In Locoregionally Advanced Nasopharyngeal Carcinoma-A Meta-analysis

Objective: Nasopharyngeal carcinoma(NPC)has a high incidence in Southeast Asia.National Comprehensive Cancer Network(version 1.2015)has recommended concurrent chemoradiotherapy(CCRT)followed by adjuvant chemotherapy(AC)for locoregionally advanced NPC(category 2A),but AC leads to normal tissue and organs reaction adversely.This meta-analysis aim to compare CCRT+AC versus CCRT to locoregionally advanced NPC.Methods: We have searched randomized controlled trials about CCRT+AC versus CCRT in Pubmed,Embase,CENTROL,Web of Science,CNKI,WANFANG and VIP.Publication dates of studies were limited the date before 2015-12-31.The primary end point was OS while the secondary end points were LRFS,DMFS and PFS.The quality ofevidence was assessed by GRADE profiler.4 randomized controlled trials were included in this meta-analysis.Results: There were 820 participants in 4 trials totally,and 3,2,3 studies of these 4 trials regarding OS,DMFS and PFS,respectively.The only one LRFS calculation in these studies did not fit the conditions of meta-analysis.There was no significant difference between CCRT+AC and CCRT in 3-year OS,DMFS and PFS.The hazard ratios(HRs)were 0.69(95%CI 0.48-1.01),0.75(95%CI 0.50-1.13)and 0.72(95%CI 0.51-1.02),respectively.The grade 3-4 haematological and mucosal toxicites happened generally during AC.The GRADE evidences were low level in DMFS and very low level in OS and PFS.Conclusion: Our review suggested CCRT+AC did not improve the 3-year OS,DMFS and PFS when compared CCRT in locoregionally advanced NPC,but increased the grade 3-4 haematological toxicity and mucositis.