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292

KUANetal.

TABLE XXV.6 Evidence surrounding concurrent chemoradiation in NPC treatment.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Liuet al. 1682

1. No significant survival benefit in CRT versus RT alone in OS, PFS, DMFS, or LRFS 2. CRT significantly increases the risk of acute grade 3–4 leukopenia compared with RT alone 1. Addition of chemotherapy to RT significantly improved OS 2. Interaction between treatment effect on OS and the timing of chemotherapy was significant, in favor of CRT plus adjuvant chemotherapy and CRT without adjuvant chemotherapy and suggested that these two schedules are very close in terms of benefit 3. Chemotherapy was not associated with increase in noncancer mortality 4. CRT plus adjuvant chemotherapy was associated with the highest frequency of acute toxicities 1. No significant difference between weekly versus triweekly groups in terms of 5-year OS, FFS, DMFS, and LRFS 2. Significantly higher incidence of anemia and lower incidence of vomiting in weekly group versus triweekly group 3. Cisplatin 30 mg/m 2 with at least six cycles could be a more feasible concurrent strategy than 40mg/m 2 /week 4. Both cisplatin 80 mg/m 2 and 100mg/m 2 CRT have highly treatment compliance in triweekly regimens and with no obvious differences in survival responses 1. CTX + CRT group significantly improved 3-year DFS and DMFS compared with CRT group 2. No significant improvement in OSandLRFS 3. CTX + CRT group was associated with more grade 3–4 skin rash, mucositis, and dermatitis, and no significant difference in weight loss, hematological, and gastrointestinal adverse events (Continues)

1. OS 2. PFS, DMFS, andLRFS

2018 1

Meta-analysis 1302 patients with stage II NPC in seven studies IMRT alone versus

IMRTplus concurrent chemotherapy

Baujat

2006,

updated 2015 1

Meta-analysis 4806 patients from 19 trials (1753 patients from eight trials in prior meta-analysis) RT versus CRT regimens, with focus onroleof chemotherapy

1. OS 2. PFS 3. Event-free survival

et al. 1756 Blan chard et al. 1658

Tanget al. 1684

1. 5-year OS 2. 5-year FFS, DMFS, and LRFS 3. Toxicities

1515 patients from six studies Weekly versus triweekly cisplatin dosing

2021

2

Systematic

review with pooled analysis

Wanget al. 1757

2019 2

Meta-analysis 1744 patients of stage II-IVb NPC in five retrospective studies Cisplatin-based CRT with or without cetuximab

1. OS 2. DMFS, LRFS andDFS 3. Adverse events