Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy: a meta-analysis

PURPOSE: In this study, we attempted to compare the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with radiotherapy alone (RT) for locoregionally advanced nasopharyngeal carcinoma (LANPC) in the era of intensity-modulated radiotherapy (IMRT) by meta-analysis. MATERIALS AND METHODS: We searched databases, and all randomized controlled trials meeting the inclusion criteria were utilized for a meta-analysis with RevMan 5.3 based on the Cochrane methodology. RESULTS: Fifteen studies were found suitable based on the inclusion criteria. CCRT not only significantly improved the overall response rate (risk ratio [RR]=0.53, 95% CI 0.43–0.66) and the complete response rate (RR=0.60, 95% CI 0.51–0.71) but also contributed to longer overall survival. The incidence of grade 3–4 adverse events from CCRT group increased in hematologic toxicity (RR 2.25, 95% CI 1.54–3.29), radiation-induced oral mucositis (RR 1.64, 95% CI 1.14–2.35), and radiodermatitis (RR 1.80, 95% CI 1.13–2.88). CONCLUSION: Compared with IMRT alone, CCRT provided survival benefit with acceptable toxicity in patients with LANPC. However, we need multicenter randomized controlled trials and long-term follow-up to evaluate the eventual efficacy and toxicity of concurrent chemotherapy plus IMRT.