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

TitleWhat Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis
Authors
Issue Date2017
PublisherAmerican Society of Clinical Oncology. The Journal's web site is located at http://www.jco.org/
Citation
Journal of Clinical Oncology, 2017, v. 35 n. 5, p. 498-505 How to Cite?
AbstractPurpose: 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.
Persistent Identifierhttp://hdl.handle.net/10722/248396
ISSN
2019 Impact Factor: 32.956
2015 SCImago Journal Rankings: 9.204
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorRibassin-Majed, L-
dc.contributor.authorMarguet, S-
dc.contributor.authorLee, AWM-
dc.contributor.authorNg, WT-
dc.contributor.authorMa, J-
dc.contributor.authorChan, ATC-
dc.contributor.authorHuang, PY-
dc.contributor.authorZhu, G-
dc.contributor.authorChua, DTT-
dc.contributor.authorChen, Y-
dc.contributor.authorMai, HQ-
dc.contributor.authorKwong, DLW-
dc.contributor.authorCheah, SL-
dc.contributor.authorMoon, J-
dc.contributor.authorTung, Y-
dc.contributor.authorChi, KH-
dc.contributor.authorFountzilas, G-
dc.contributor.authorBourhis, J-
dc.contributor.authorPigeon, JP-
dc.contributor.authorBlanchard, P-
dc.date.accessioned2017-10-18T08:42:32Z-
dc.date.available2017-10-18T08:42:32Z-
dc.date.issued2017-
dc.identifier.citationJournal of Clinical Oncology, 2017, v. 35 n. 5, p. 498-505-
dc.identifier.issn0732-183X-
dc.identifier.urihttp://hdl.handle.net/10722/248396-
dc.description.abstractPurpose: 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.-
dc.languageeng-
dc.publisherAmerican Society of Clinical Oncology. The Journal's web site is located at http://www.jco.org/-
dc.relation.ispartofJournal of Clinical Oncology-
dc.rights© 2016 by American Society of Clinical Oncology.-
dc.titleWhat Is the Best Treatment of Locally Advanced Nasopharyngeal Carcinoma? An Individual Patient Data Network Meta-Analysis-
dc.typeArticle-
dc.identifier.emailLee, AWM: awmlee@hkucc.hku.hk-
dc.identifier.emailNg, WT: ngwt1@hkucc.hku.hk-
dc.identifier.emailKwong, DLW: dlwkwong@hku.hk-
dc.identifier.authorityLee, AWM=rp02056-
dc.identifier.authorityNg, WT=rp02671-
dc.identifier.authorityKwong, DLW=rp00414-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1200/JCO.2016.67.4119-
dc.identifier.pmid27918720-
dc.identifier.pmcidPMC5791836-
dc.identifier.scopuseid_2-s2.0-85012120227-
dc.identifier.hkuros280520-
dc.identifier.volume35-
dc.identifier.issue5-
dc.identifier.spage498-
dc.identifier.epage505-
dc.identifier.isiWOS:000405989600005-
dc.publisher.placeUnited States-

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