2798 - Safety and Efficacy of Local Radiotherapy in De Novo Metastatic Nasopharyngeal Carcinoma with Immunochemotherapy: Systematic Review and Meta-Analysis
Presenter(s)
L. Ma1, F. Fu2, J. Zhang3, and S. Qiu4; 1National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China, 2National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospitaal&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, shenzhen, China, 3Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 4Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
Purpose/Objective(s): Immunochemotherapy is the standard care of newly diagnosed metastatic nasopharyngeal carcinoma (NPC). Limited trials with small sample sizes reported the potential benefit of delivering radiotherapy in these patients. The purpose of our systematic review and meta-analysis was to examine the efficacy and toxicity of local radiotherapy when combined with immuno-chemotherapy as the first-line treatment in newly diagnosed metastatic NPC, providing a reference for clinicians to make the best choice in clinical practice.
Materials/Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane Library, Medline, and CNKI to identify published literature between January 1, 2004, and till present to identify potential eligible studies including patients with pathologically confirmed de novo metastatic NPC treated with radiotherapy and immunochemotherapy. Toxicity rates and progression-free survival (PFS) for the endpoints of interest were extracted from the articles, and the 95% confidence intervals (CIs) were estimated.
Results: Six studies with a total of 366 patients were analyzed to evaluate the efficacy and toxicity of first-line local radiotherapy and immunochemotherapy in newly diagnosed metastatic NPC. The results showed that the addition of radiotherapy to immunochemotherapy significantly improved PFS in de novo metastatic NPC (HR 0.60 [0.45, 0.82]) using a fixed-effects model (I² =0%, P = 0.09).The pooled event rates of toxicities are 62.52% (95%CI 25.22%-92.73%, I² = 97.8%), 63.03% (95%CI 29.6%-90.6%, I² = 97.2%), 57.54% (95%CI 30.72%-82.15%, I²=95.6%), 21.29% (95%CI 8.08%-39.37%, I² = 91.2%), 7.12% (95%CI 0.33%-21.55%, I² = 87.1%) for mucositis, dermatitis, xerostomia, ear toxicity, and trismus of all grades, respectively. Severe mucositis, dermatitis, xerostomia, ear toxicity, and trismus were 9.57% (95%CI 3.37%-18.49%, I² = 79.4%), 3.5% (95%CI 1.87%-5.63%, I² = 19.3%), 0.39% (95%CI 0.01%-1.29%, I² = 37.4%), 1.37% (95%CI 0.01%-4.95%, I² = 69.3%) and 0.26% (95%CI 0%-1.25%, I² = 0%), respectively.
Conclusion: Radiotherapy combined with immunochemotherapy in de novo metastatic NPC may improve PFS. The pooled toxicity rate derived in this systematic review and meta-analysis can be a guide for clinical decision-making and patient management.