Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized, controlled trials.

BACKGROUND We carried out this meta-analysis to demonstrate efficacies of neoadjuvant chemotherapy (NACT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC) patients based on randomized, controlled trials (RCTs). PATIENTS AND METHODS We comprehensively searched electronic databases and manuscripts for RCTs and extracted data from eligible studies for meta-analysis. Overall survival (OS) with hazard ratios (HRs), locoregional recurrence rate (LRR) and distant metastasis rate (DMR) with relative risks (RRs) were concerned using random and/or fixed-effects models. Subgroup and sensitivity analyses were also carried out. RESULTS Six trials in NACT group (n = 1418) and five in AC group (n = 1187) were eligible. HR of death for NACT was 0.82 [95% confidence interval (CI) 0.69-0.98, P = 0.03], corresponding to an absolute survival gain of 5.13% after 3 years. Significant reduction of DMR (P = 0.0002; RR 0.69, 95% CI 0.56-0.84) was also found from NACT. But no decrease in LRR (P = 0.49; RR 0.90, 95% CI 0.66-1.22) was observed. Patients receiving additional AC had lower LRR (P = 0.03; RR 0.71, 95% CI 0.53-0.96). But no benefit of OS and DMR were seen in AC. CONCLUSIONS NACT can effectively enhance OS and reduce DMR, not LRR in NPC. And AC only helps to better control locoregional recurrence of NPC.