title: Significant benefits of adding neoadjuvant chemotherapy before concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We did a meta-analysis to compare the efficacy and safety of neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy (CCRT) versus CCRT with or without adjuvant chemotherapy (AC) for patients with locoregionally advanced nasopharyngeal carcinoma based on randomized controlled trials.
  
  
  METHODS
  We searched PubMed, Embase, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure, and meeting proceedings of major relevant conferences to identify published and unpublished randomized controlled trials. Progression-free survival (PFS) was the primary endpoint.
  
  
  RESULTS
  This meta-analysis included 9 randomized clinical trials with 2215 patients. NACT followed by CCRT significantly improved PFS (HR=0.68, 95% CI 0.56 - 0.81, P < 0.001) compared versus CCRT with or without AC, and no heterogeneity was observed (I2 = 0.0%, P = 0.975). NACT was associated with a significant improvement in overall survival (HR = 0.64, 95% CI 0.49 - 0.84, P = 0.001; I2 = 0.0%, P = 0.467) and distant failure-free survival (HR = 0.72, 95% CI 0.53 - 0.97, P = 0.031; I2 = 0.0%, P = 0.744). No significant benefit was shown by NACT for locoregional control. NACT with CCRT increased risks of grade 3 - 4 anemia, thrombocytopenia, leukopenia, and fatigue, compared versus CCRT with or without AC.
  
  
  CONCLUSIONS
  Our meta-analysis confirmed that the addition of NACT to CCRT significantly improved PFS and OS versus CCRT with or without AC for locoregionally advanced nasopharyngeal carcinoma. These results may alter the standard of care - CCRT with or without AC, for locoregionally advanced nasopharyngeal carcinoma.
authors.affiliation: Cancer Center, The First Hospital of Jilin University, Changchun, China.
authors.forename: Mengmeng
authors.initials: M
authors.lastname: Wang
authors.affiliation: Cancer Center, The First Hospital of Jilin University, Changchun, China.
authors.forename: Huimin
authors.initials: H
authors.lastname: Tian
authors.affiliation: Department of Thyroid and Breast Surgery, No.458 Hospital of People's Liberation Army, Guangzhou, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: Cancer Center, The First Hospital of Jilin University, Changchun, China.
authors.forename: Tingwen
authors.initials: T
authors.lastname: Ge
authors.affiliation: Cancer Center, The First Hospital of Jilin University, Changchun, China.
authors.forename: Yudi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Cancer Center, The First Hospital of Jilin University, Changchun, China.
authors.forename: Jiuwei
authors.initials: J
authors.lastname: Cui
authors.affiliation: Cancer Center, The First Hospital of Jilin University, Changchun, China.
authors.forename: Fujun
authors.initials: F
authors.lastname: Han
mesh_terms: D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D006801:Humans; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D020360:Neoadjuvant Therapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
keywords: adjuvant chemotherapy; concurrent chemoradiotherapy; meta-analysis; nasopharyngeal carcinoma; neoadjuvant chemotherapy