Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients.
OBJECTIVE
To study the effect of adding chemotherapy to radiotherapy (RT) on overall survival and event-free survival for patients with nasopharyngeal carcinoma.


METHODS
This meta-analysis used updated individual patient data from randomized trials comparing chemotherapy plus RT with RT alone in locally advanced nasopharyngeal carcinoma. The log-rank test, stratified by trial, was used for comparisons, and the hazard ratios of death and failure were calculated.


RESULTS
Eight trials with 1753 patients were included. One trial with a 2 x 2 design was counted twice in the analysis. The analysis included 11 comparisons using the data from 1975 patients. The median follow-up was 6 years. The pooled hazard ratio of death was 0.82 (95% confidence interval, 0.71-0.94; p = 0.006), corresponding to an absolute survival benefit of 6% at 5 years from the addition of chemotherapy (from 56% to 62%). The pooled hazard ratio of tumor failure or death was 0.76 (95% confidence interval, 0.67-0.86; p < 0.0001), corresponding to an absolute event-free survival benefit of 10% at 5 years from the addition of chemotherapy (from 42% to 52%). A significant interaction was observed between the timing of chemotherapy and overall survival (p = 0.005), explaining the heterogeneity observed in the treatment effect (p = 0.03), with the highest benefit resulting from concomitant chemotherapy.


CONCLUSIONS
Chemotherapy led to a small, but significant, benefit for overall survival and event-free survival. This benefit was essentially observed when chemotherapy was administered concomitantly with RT.
Baujat
Bertrand
B
Institut Gustave-Roussy, Villejuif, France.
Audry
Hélène
H
Bourhis
Jean
J
Chan
Anthony T C
AT
Onat
Haluk
H
Chua
Daniel T T
DT
Kwong
Dora L W
DL
Al-Sarraf
Muhyi
M
Chi
Kwan-Hwa
KH
Hareyama
Masato
M
Leung
Sing F
SF
Thephamongkhol
Kullathorn
K
Pignon
Jean-Pierre
JP
D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D006801:Humans; D016014:Linear Models; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D016032:Randomized Controlled Trials as Topic
D000970:Antineoplastic Agents