title: Increased treatment-related mortality with additional cisplatin-based chemotherapy in patients with nasopharyngeal carcinoma treated with standard radiotherapy.
abstract: OBJECTIVE
  We performed a meta-analysis of randomized controlled trials (RCTs) to determine the overall risk of treatment-related death associated with additional cisplatin-based chemotherapy in patients with nasopharyngeal carcinoma treated with standard radiotherapy.
  
  
  METHODS
  Eligible studies included RCTs in which cisplatin-based chemotherapy in combination with radiotherapy was compared with radiotherapy alone. Statistical analyses were conducted to calculate the summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) using fixed- or random-effects models based on the heterogeneity of included studies.
  
  
  RESULTS
  A total of 2829 patients from 13 RCTs were included in this study. The overall incidence for treatment-related death in chemoradiotherapy and radiotherapy treated patients was 1.7% and 0.8%. Compared to radiotherapy alone, radiotherapy plus cisplatin-based chemotherapy significantly increased the risk of treatment-related mortality. On subgroup analyses, no difference was found in treatment-related mortality between different timings of chemotherapy and chemotherapeutic agents. Adding cisplatin-based chemotherapy was associated with higher incidences of severe acute toxicity.
  
  
  CONCLUSIONS
  Cisplatin-based chemotherapy plus radiotherapy increased the risk of treatment-related death and severe acute toxicity, compared with radiotherapy alone. Better management of treatment toxicity might improve the therapeutic gain in patients with nasopharyngeal carcinoma.
authors.affiliation: Third Military Medical University, Chongqing, China.
authors.forename: An-Mei
authors.initials: AM
authors.lastname: Zhang
authors.forename: Ye
authors.initials: Y
authors.lastname: Fan
authors.forename: Xin-Xin
authors.initials: XX
authors.lastname: Wang
authors.forename: Qi-Chao
authors.initials: QC
authors.lastname: Xie
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Sun
authors.forename: Zheng-Tang
authors.initials: ZT
authors.lastname: Chen
authors.forename: Bo
authors.initials: B
authors.lastname: Zhu
mesh_terms: D002277:Carcinoma; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects; D006801:Humans; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D002945:Cisplatin