| Nasopharyngeal carcinoma is the most common malignant tumor in China, and ranks the first place in the head and neck cancers. Patients with nasopharyngeal carcinoma traditionally have been treated with radiotherapy alone. The probability of cure for patient with Stageâ… andâ…¡NPC is high. Nearly 70% of the patients diagnosed with nasopharyngeal carcinoma with present with Stageâ…¢andâ…£. The response of these nasopharyngeal carcinoma patients to radiation alone is known to be poor. A 5-year survival rate of only 20%~30% in patients with advanced locoregional disease because of both local recurrences and distant metastasis almost 40%~45%. NPC has been shown to be a highly chemosensitive tumor, and there are reports of long-standing complete response for patients with distant metastasis who are given adequate chemotherapies. The role of neoadjuvant chemotherapy in advanced nasopharyngeal carcinoma has been the subject of numerous investigations for many years. The theoretic basis of neoadjuvant chemotherapy is to enhance locoregional control by tumor debunking or sensitizing the tumor to radiation and to decrease distant metastasis by treating occult micrometastasis.The alleged evidence-based medicine is the clinical medicine followed evidence. Evidence-based medicine aims to apply evidence gained from the scientific method to certain parts of medical practice. Meta-analysis method is the core of evidence-based medicine. As a reliable, feasible, literature reviewed method, Meta-analysis can increase sample size, reduce bias and error, enhance the effectiveness of testing and finally produce reliable conclusions.Although the theoretic superiorities of neoadjuvant chemotherapy in the treatment of nasopharyngeal carcinoma and numerous retrospective and pilot studies have reported promising results, many have reported quite the opposite. The objective of the present study was to collect the data of relative clinical studies, and use the Meta-analysis method to quantitative analysis the effects of neoadjuvant chemotherapy for the prognosis of the patients with nasopharyngeal carcinoma.Chinese Biomedical Database, OVID-medline, the Cochrane Library and EMBASE were searched from the beginning to December 2007, and the references of eligible studies were annually screened. Randomized controlled trials comparing neoadjuvant chemotherapy plus radiotherapy vs. radiotherapy alone were eligible for inclusion. Randomized trials were collected and evaluated according to the inclusion and exclusion criteria. In this study, the Meta-analysis software package RevMan4.2 which the Cochrane Collaboration provided to compute statistically is used to complete the statistical analysis. The 5-year overall survival, 5-year disease free survival, locoregional recurrence rate and distant metastasis rate were to observe. According to the result of heterogeneity test, the researches which have homogeneity were carried on by adequate model and method. And the test of the combining variables, sensitiveness analysis and publication bias analysis were carried out by the RevMan4.2 software.Five randomized clinical studies including 1286 patients were selected in this meta-analysis. There was no significant difference between the neoadjuvant chemotherapy plus radiotherapy group and the radiotherapy alone group in the 5-year overall survival (OR=0.84, 95%CI:0.67~1.05, P=0.14) and 5-year disease free survival (OR=0.65,95%CI:0.51~0.84, P=0.0001) respectively. The neoadjuvant chemotherapy plus radiotherapy group reduce the locoregional recurrence rate (OR=0.65, 95%CI:0.50~0.84, P=0.0009) and the distant metastasis rate (OR=0.65, 95%CI:0.51~0.84, P=0.0001) significantly. The neoadjuvant chemotherapy in the treatment of nasopharyngeal carcinoma can reduce the locoregional recurrence and the distant metastasis odd risk at 0.35 respectively.From above results, we can draw such conclusion: The neoadjuvant chemotherapy in the treatment of nasopharyngeal carcinoma can not gain in 5-year overall survival and 5-year disease free survival, but can enhance locoregional control and decrease distant metastasis. However, because of the small samples in some eligible studies, and the limitation of the number of randomized controlled trials, completely accurate conclusions can not been drawn. So we still need to launch a series of large-scale, multi-center, prospective, randomized controlled clinical trials so as to expand the sample size and then to provide sufficient evidence for neoadjuvant chemotherapy in the treatment of nasopharyngeal carcinoma for clinical practice.
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