The Efficacy And Adverse Reaction Of Neoadjuvant Chemotherapy Combined With Concurrent Chemoradiotherapy For Locoregionally Advanced Nasopharyngeal Carcinoma-a Meta-analysis Of Randomized Controlled Trials

Objective:To evaluate the efficacy and adverse reaction of neoadjuvant chemotherapy plus concurrent chemoradiotherapy(IC+CCRT)versus concurrent chemoradiotherapy with or without adjuvant chemotherapy(CCRT±AC)for locoregionally advanced nasopharyngeal carcinoma.Method:Retrieval of PubMed,Embase,Web of Science,the Cochrane Library,China National Knowledge Infrastructure(CNKI),Wan Fang Database,and database for Chinese Technical Periodicals(VIP),etc.At the same time we also manually searched the references and summaries of important meetings.Clinical randomized controlled trials(RCT)of IC+CCRT and CCRT±AC for local advanced nasopharyngeal carcinoma,According to The Cochrane collaboration's tool for assessing risk of bias,The risk bias evaluation was carried out in a form.Meta analysis was used by Stata 12.0 software.Results:A total of 12 RCTs(2567 cases)were included.The IC+CCRT group significantly improved the PR of patients with local advanced nasopharyngeal carcinoma for 3-4 months after chemoradiotherapy.(RR=0.60,95%CI 0.38-0.94,P=0.026;I~2=42.4%,P=0.18),OS,DFS,DMFS???(HR=0.68,95%CI 0.57-0.82,P<0.0001;I~2=0.0%,P=0.54),(HR=0.77,95%CI0.63-0.93,P=0.008;I~2=0.0%,P=0.70),(HR=0.68,95%CI 0.55-0.83,P=0.000;I~2=0.0%,P=0.76),But the LRFS did not improve significantly(HR=0.85,95%CI 0.63-1.14,P=0.257;I~2=0.0%,P=0.55);Whether the neoadjuvant chemotherapy contains Taxol has no significant effect on the overall survival rate and no distant metastasis survival rate(P<0.05);Compared with conventional radiotherapy,increased neoadjuvant chemotherapy significantly improved the OS of patients with IMRT/3D-CRT group(HR=0.64,95%CI 0.52-0.80,P=0.00;I~2=45.7%,P=0.137);In addition,the IC+CCRT group increased the adverse reaction by 3-4 levels compared with CCRT+AC group.The blood system is shown in leukopenia(HR=0.34,95%CI0.26-0.44,P<0.00001;I~2=68%,P=0.001),thrombocytopenia(OR=0.20,95%CI 0.11-0.37,P<0.00001;I~2=15%,P=0.32),Non-blood systems are manifested in fatigue.(OR=2.85,95%CI1.13-7.18,P=0.03;I~2=50%,P=0.13).There was no statistically significant between the other skin mucosa and gastrointestinal tract.Conclusions:1.The IC+CCRT group significantly improved the recent partial response(3-4month after the end of chemoradiotherapy),overall survival,disease-free survival,and distant metastasis-free survival in patients with local advanced nasopharyngeal carcinoma;2.The neoadjuvant chemotherapy cycle and the presence of Taxol had no significant effect on the overall survival rate and no distant metastasis survival rate;3.Increased neoadjuvant chemotherapy significantly improved the OS of patients with IMRT/3D-CRT group;4.Neoadjuvant chemotherapy increases the incidence of adverse events at the level of 3-4.The blood system mainly includes leukopenia,thrombocytopenia,and non-blood system mainly for fatigue.However,the patient can be basically tolerated through symptomatic treatment.