What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis.

Détails

ID Serval
serval:BIB_47F24284E77D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
What Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis.
Périodique
Journal of clinical oncology
Auteur(s)
Ribassin-Majed L., Marguet S., Lee AWM, Ng W.T., Ma J., Chan ATC, Huang P.Y., Zhu G., Chua DTT, Chen Y., Mai H.Q., Kwong DLW, Cheah S.L., Moon J., Tung Y., Chi K.H., Fountzilas G., Bourhis J., Pignon J.P., Blanchard P.
ISSN
1527-7755 (Electronic)
ISSN-L
0732-183X
Statut éditorial
Publié
Date de publication
10/02/2017
Peer-reviewed
Oui
Volume
35
Numéro
5
Pages
498-505
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis
Publication Status: ppublish
Résumé
Purpose The role of adjuvant chemotherapy (AC) or induction chemotherapy (IC) in the treatment of locally advanced nasopharyngeal carcinoma is controversial. The individual patient data from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma database were used to compare all available treatments. Methods All randomized trials of radiotherapy (RT) with or without chemotherapy in nonmetastatic nasopharyngeal carcinoma were considered. Overall, 20 trials and 5,144 patients were included. Treatments were grouped into seven categories: RT alone (RT), IC followed by RT (IC-RT), RT followed by AC (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concomitant chemoradiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). P-score was used to rank the treatments. Fixed- and random-effects frequentist network meta-analysis models were applied. Results The three treatments with the highest probability of benefit on overall survival (OS) were CRT-AC, followed by CRT and IC-CRT, with respective hazard ratios (HRs [95% CIs]) compared with RT alone of 0.65 (0.56 to 0.75), 0.77 (0.64 to 0.92), and 0.81 (0.63 to 1.04). HRs (95% CIs) of CRT-AC compared with CRT for OS, progression-free survival (PFS), locoregional control, and distant control (DC) were, respectively, 0.85 (0.68 to 1.05), 0.81 (0.66 to 0.98), 0.70 (0.48 to 1.02), and 0.87 (0.61 to 1.25). IC-CRT ranked second for PFS and the best for DC. CRT never ranked first. HRs of CRT compared with IC-CRT for OS, PFS, locoregional control, and DC were, respectively, 0.95 (0.72 to 1.25), 1.13 (0.88 to 1.46), 1.05 (0.70 to 1.59), and 1.55 (0.94 to 2.56). Regimens with more chemotherapy were associated with increased risk of acute toxicity. Conclusion The addition of AC to CRT achieved the highest survival benefit and consistent improvement for all end points. The addition of IC to CRT achieved the highest effect on DC.

Mots-clé
Antineoplastic Agents/therapeutic use, Carcinoma/therapy, Chemoradiotherapy, Chemotherapy, Adjuvant, Combined Modality Therapy/adverse effects, Combined Modality Therapy/methods, Disease-Free Survival, Humans, Induction Chemotherapy, Nasopharyngeal Neoplasms/therapy, Network Meta-Analysis, Randomized Controlled Trials as Topic, Survival Rate
Pubmed
Web of science
Création de la notice
12/12/2016 20:33
Dernière modification de la notice
03/03/2018 16:51
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