Efficacy and Safety of Concurrent Chemoradiotherapy Combined With Induction Chemotherapy or Adjuvant Chemotherapy in Patients With Stage II-IVA Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis and Meta-Analysis.

Purpose: To evaluate the efficacy and safety of induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) CCRT combined with adjuvant chemotherapy (AC) in patients with stage II-IVA nasopharyngeal carcinoma (NPC), we conducted a retrospective study and a meta-analysis combining the results of our studies.

Patients And Methods: We used the propensity score matching (PSM) to balance variables. A total of 168 patients were chosen by one-to-two PSM, including 101 patients with IC + CCRT and 67 cases with CCRT + AC. We used the Kaplan-Meier curve to compare survival outcomes and also used Cox regression analysis to determine independent prognostic factors. For meta-analysis, we determined the related studies by searching the PubMed database. We used STATA v12 software to perform meta-analysis of the extracted data and calculate pooled hazard ratios, 95% confidence intervals of survival outcomes, and risk ratios for the toxicities.

Results: In this retrospective study, there was no significant difference in 5-year overall survival (76.9% . 79.0%, = 0.966), progression-free survival (71.3% . 68.5%,  = 0.332), distant metastasis-free survival (80.5% . 74.2%, = 0.140), and locoregional relapse-free survival (91.5% . 91.8%, = 0.894) among patients with NPC with IC + CCRT CCRT + AC after PSM. For meta-analysis, six articles (including our study) reporting 1,052 cases of IC + CCRT and 883 cases of CCRT + AC were included in the meta-analysis. There was no difference of OS (pooled HR = 0.90, 95% CI: 0.63-1.29,  = 0.561), PFS (pooled HR = 1.07, 95% CI: 0.87-1.33, = 0.633), DMFS (pooled HR= 0.98, 95% CI: 0.76-1.25, =0.861), and LRRFS (pooled HR = 1.06, 95% CI: 0.76-1.48, = 0.724).

Conclusion: The efficacy of IC + CCRT and CCRT + AC was comparable in patients with stage II-IVA NPC. In terms of compliance and acute adverse reactions, IC + CCRT may be a potential therapeutic strategy.