| Objective1.To compare the treatment outcomes,acute and chronic adverse reactions of patients with nasopharyngeal carcinoma after three-dimensional conformal radiotherapy or intensity modulated radiotherapy.2.An evidence based meta-analysis of randomized controlled trials conducted in China and abroad on the efficacy of three-dimensional conformal radiotherapy or intensity modulated radiotherapy for patients with nasopharyngeal carcinoma was performed.Methods1.One hundred and fifteen patients with nasopharyngeal carcinoma underwent radiotherapy at oncology department of Affiliated hospital of Youjiang Medical University for Nationalities from January 2012 to December 2013,of which 50 patients received three-dimensional conformal radiotherapy(Three-dimensional conformal radiotherapy group)and 65 patients received intensity-modulated radiotherapy(Intensive radiotherapy group),were included and retrospectively analyzed the age,sex,pathological type,clinical stage and other general information.Besides,short-term efficacy,long-term survival rate,local control rate,progression-free survival rate,non-distal metastatic survival rate,acute and chronic complications and change of EB antibody titer were compared between the two groups.2.Randomized controlled trails published in China and abroad after January 2000 on the treatment outcomes and adverse reactions of three-dimensional conformal and intensity modulated radiotherapy for patients with nasopharyngeal carcinoma were included by searching Pubmed,EMBASE,CJFD,Vip andWanfang database,according to our established screening strategies.Results Clinical research1.Short-term efficacy: After the completement of whole radiotherapy plan,the total effective rate(complete remission + partial remission)in three-dimensional conformal radiotherapy group and intensive radiotherapy group was 96%(48/50)and 96.92%(63/65),respectively.There was no significant difference in short-term efficacy between the two groups(p> 0.05).2.Long-term efficacy:The one-year survival rate,two-year survival rate and thtee-year survivial rate after radiotherapy in three-dimensional conformal group were 96%(48/50),78%(39/50),and 60%(30/50),respectively,and those in intensity-modulated radiotherapy group were 98.46%(64/65),80.00%(52/65)and 61.54%(40/65),respectively.There were no significant difference in survival rates between the two groups(p> 0.05).The 3-year progression-free survival rate,local control rate,recurrence-free survival rate and metastasis-free survival rate were 46%(23/50),40%(20/50),52% 50),50%(25/50)in in three-dimensional conformal group,respectively,and those were 49.23%(32/65),53.85%(35/65),50.77%(33/65)and 60.00%(39/65)in intensity-modulated radiotherapy group,respectively.No significant differences in those parameters were found between the two groups(p> 0.05).3.Acute adverse reactions:The adverse reactions on salivary gland and neutrophil were significantly reduced in intensity-modulated radiotherapy group than those in the three-dimensional conformal radiotherapy group(p <0.05).There were no significant differences in the incidences of skin lesions,mucosal damage,white blood cell,platelet and hemoglobin abnormalities between the two groups(p >0.05).4.Chronic complications: The rate of the parotid gland injury in intensity-modulated radiotherapy group was less than that in the three-dimensional conformal radiotherapy group(p<0.05).However,there were no significant differences in the incidence rates of xerostomia,taste lesion,trismus,otitis media,nasal adhesions,tooth loss and cranial nerve injury between the two groups(p >0.05)..5.There were no statistically significant differences in the antibody titer of Zta-IgA,EBNA1-IgA and VCA-IgA of patients between the two groups(p>0.05).Meta analysis1.According to the pre-set literature search strategy,a total of 1285 articles were retrieved.There were 958 articles remained after removing duplicate publications and repeated retrieved literatures in different databases were excluded and 162 literatures were remained after reading the abstract to exclude the non-clinical or irrelevant studies.Based on the inclusion and exclusion criterion,a total of six articles were enrolled into the meta-analysis after full text reading.2.The Cochrane ROB tool was used to assess the overall bias risk for included studies.Two studies was evaluated as “high overall bias risk”,while four studies were evaluated as “unable to determine bias”.3.Main results of meta-analysis.In the four randomized controlled trials included in the meta-analysis,there was no significant difference of short-term efficacy in treatment of nasopharyngeal carcinoma between three-dimensional conformal radiotherapy group and intensity-modulated radiotherapy group [OR = 0.65,95% CI(0.25-1.70),p = 0.38].There was no significant difference in the long-term survival rate between the two groups [OR = 0.82,95% CI(0.63-1.05),p = 0.12].IMRT significantly improved the local control rate of nasopharyngeal carcinoma than 3D-CRT [OR = 0.53,95% CI(0.33-0.87),p = 0.01].There was no significant difference in progression-free survival rate in the two groups in four randomized controlled trials [OR = 0.89,95% CI(0.55-1.44),p = 0.63].There was no significant difference in metastases-free survival rate between the two groups in five randomized controlled trails [OR = 0.89,95% CI(0.68-1.17),p = 0.41].4.Secondary outcomes of meta-analysis.In 6 randomized controlled trials,the incidence rate of xerostomia in patients was significantly lower in IMRT group than that of 3D-CRT group [OR = 3.00,95% CI(1.15-7.84),p =0.02].Four included studies showed there was no significant difference in trismus between 3D-CRT group and IMRT group [OR = 1.24,95% CI(0.92-1.66),p = 0.15].Three randomized controlled trials showed incidence of cranial nerve injury in IMRT group was significantly lower than that of 3D-CRT group [OR = 10.18,95% CI(2.88-26.21)),p = 0.0003].ConclusionsIntensity-modulated radiotherapy,compared with three-dimensional conformal radiotherapy at least has a comparable efficacy for nasopharyngeal carcinoma treatment,.However,it might have more advantages in improving local control rate and reducing the incidence of adverse reactions. |
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