title: Concurrent chemoradiotherapy was associated with a higher severe late toxicity rate in nasopharyngeal carcinoma patients compared with radiotherapy alone: a meta-analysis based on randomized controlled trials.
abstract: BACKGROUND
  To investigate the incidence and risk of severe late toxicity with concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma patients.
  
  
  METHODS
  Eligible studies included prospective randomized controlled trials (RCTs) evaluating CCRT versus radiotherapy alone in patients with nasopharyngeal carcinoma and in which data on severe late toxicities were available. Random effects or fixed effect models were applied to obtain the summary incidence, relative risks (RRs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Five RCTs with 1102 patients with NPC were included in this analysis. The summary incidence of overall severe late toxicities in patients receiving CCRT was 30.7% (95% CI, 18-47.2%) and the incidence of radiotherapy alone group was 21.7% (95% CI, 13.3-33.4%). The use of concurrent chemotherapy was associated with an increased risk of severe late toxicities, with a RR of 1.349 (95% CI, 1.108-1.643; P = 0.005). As for specific late toxicity, CCRT significantly increased the risk of ear deafness/otitis (RR = 1.567; 95% CI, 1.192-2.052), but other late toxicities were not significantly different. Patients receiving concurrent chemotherapy regimens with 3-week high-dose cisplatin (HC) have a higher risk of ear deafness/otitis (RR = 1.672; 95% CI, 1.174-2.382; P = 0.026). However, there was no significant increase in the RR of severe ear complication with the addition of non-3-week high-dose cisplatin (nonHC) regimens (RR = 1.433; 95% CI, 0.946-2.171; P = 0.095).
  
  
  CONCLUSIONS
  With the present evidence, the addition of concurrent chemotherapy seems to increase the risk of severe late toxicities in patients with NPC, especially when using HC regimen for the occurrence of severe ototoxicity.
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, 200032, Shanghai, People's Republic of China. duchengrun2011@sina.com.
authors.forename: Cheng-Run
authors.initials: CR
authors.lastname: Du
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, 200032, Shanghai, People's Republic of China. yinghongmei2011@sina.com.
authors.forename: Hong-Mei
authors.initials: HM
authors.lastname: Ying
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, 200032, Shanghai, People's Republic of China. kongfangfang201123@sina.com.
authors.forename: Fang-Fang
authors.initials: FF
authors.lastname: Kong
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, 200032, Shanghai, People's Republic of China. zhairuiping2011223@sina.com.
authors.forename: Rui-Ping
authors.initials: RP
authors.lastname: Zhai
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, 200032, Shanghai, People's Republic of China. huchaosu2011@sina.com.
authors.forename: Chao-Su
authors.initials: CS
authors.lastname: Hu
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002277:Carcinoma / Q000532:radiotherapy / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D016001:Confidence Intervals; D003389:Cranial Nerve Diseases / Q000209:etiology; D003638:Deafness / Q000139:chemically induced / Q000209:etiology; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy / Q000628:therapy*; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D010031:Otitis / Q000139:chemically induced / Q000209:etiology; D000077150:Oxaliplatin; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012306:Risk; D017695:Soft Tissue Injuries / Q000209:etiology
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002945:Cisplatin; D005472:Fluorouracil