The Efficacy And Safety Of Docetaxel,cisplatin And Fluorouracil(TPF)-based Induction Chemotherapy Followed By Concurrent Chemoradiotherapy For Locoregionally Advanced Nasopharyngeal Carcinoma:a Meta-analysis

Objectives: In recent years,docetaxel,cisplatin and fluorouracil(TPF)-based induction chemotherapy(IC)has been widely applied in the treatment of locoregionally advanced nasopharyngeal carcinoma(LA-NPC).However,it remains unclear whether TPF is the ideal IC regimen.Thus,we carried out a meta-analysis to compare the efcacy and safety of TPF-based IC plus concurrent chemoradiotherapy(CCRT)versus CCRT alone or double-drug-based IC plus CCRT for LA-NPC.Methods: We systematically searched Pub Med,Embase and the Cochrane Library from inception until December 2018.After rigorous screening of all relevant studies that reported the use of TPF-based IC followed by CCRT for patients with LA-NPC,eight studies met the inclusion criteria and were assessed for design and quality.Among them,three articles were classifed as having a high risk of bias and were excluded from the meta-analysis.The outcomes,including overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS),locoregional failure-free survival(LRFFS)and incidence of adverse events,were pooled with the use of hazard ratio(HR)or odds ratio(OR).Heterogeneity and sensitivity analyses were also carried out.Results: Five trials involving 4223 patients were included in the meta-analysis.Compared to CCRT alone,TPF-based IC plus CCRT signifcantly improved OS(HR 0.54,95% confidence interval [CI]0.35–0.84,P=0.006),PFS(HR 0.64,95% CI 0.46–0.88,P=0.006),LRFFS(HR 0.57,95% CI 0.34–0.94,P=0.03),and DMFS(HR 0.58,95% CI0.38–0.88,P=0.01).Moreover,compared to double-drug-based IC plus CCRT,OS(HR 0.74,95% CI 0.62–0.87,P=0.0004),PFS(HR 0.76,95%CI 0.66–0.88,P=0.0001)and LRFFS(HR 0.75,95% CI 0.61–0.92,P=0.006)were also signifcantly improved by TPF-based IC plus CCRT.Notably,TPF-based IC plus CCRT mainly led to an increased risk of hematologic toxicities,such as leucopenia(OR=3.20,95% CI 2.13–4.81,P<0.0001)and neutropenia(OR=3.84,95% CI 0.66–22.36,P=0.13).However,these were uncomplicated and manageable with growth factor support.Conclusions: Compared to CCRT alone or double-drug-based IC plus CCRT,TPF-based IC plus CCRT results in better survival outcomes with manageable toxicities.Thus,it is reasonable to recommend the addition of TPF-based IC to CCRT as an excellent choice for patients with LA-NPC.