Optimal combination treatment for Locally Advanced Nasopharyngeal Carcinoma: A systematic review and Bayesian Network Meta-Analysis

Zexin Song; Likai Chen; Qi Zhang; Yueyue Huang; Hao Pan

doi:10.1016/j.amjoto.2025.104692

Optimal combination treatment for Locally Advanced Nasopharyngeal Carcinoma: A systematic review and Bayesian Network Meta-Analysis

Am J Otolaryngol. 2025 Jun 22;46(5):104692. doi: 10.1016/j.amjoto.2025.104692. Online ahead of print.

Authors

Zexin Song¹, Likai Chen¹, Qi Zhang², Yueyue Huang³, Hao Pan⁴

Affiliations

¹ School of Public Health, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China.
² Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
³ Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Zhejiang Key Laboratory of Critical Care Medicine, Wenzhou, Zhejiang 325000, China; Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, Wenzhou, Zhejiang 325000, China; Wenzhou Key Laboratory of Critical Care and Artificial Intelligence, Wenzhou, Zhejiang 325000, China.
⁴ Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325015, China. Electronic address: wzmuph@163.com.

PMID: 40578185
DOI: 10.1016/j.amjoto.2025.104692

Abstract

Purpose: To identify the optimal therapeutic strategy for Locally Advanced Nasopharyngeal Carcinoma (LA-NPC).

Methods: Herein, four databases (PubMed, Web of Science, Embase, and Cochrane Library) were systematically searched for pertinent articles from inception to May 24, 2024. Risk of Bias (ROB) was assessed using Cochrane's risk of bias tool 2.0. Statistical analyses were performed using Stata 16.0 and R 4.4.0.

Results: The final analysis included 46 studies involving 15,667 patients. Compared to the Concurrent Chemoradiotherapy (CCRT) + Adjuvant Chemotherapy (AC) combination therapy, the Induction Chemotherapy (IC) + CCRT + Epidermal Growth Factor Receptor Antibody (anti-EGFR) combination treatment demonstrated better efficacy in improving Overall Survival (OS) (Hazard Ratio [HR]: 0.52; 95 % Confidence Interval [CI]: 0.33-0.83). The Surface Under the Cumulative Ranking (SUCRA) analysis revealed that the IC + CCRT + AC + anti-EGFR combination ranked the highest in terms of OS, with a SUCRA score of 87.49 %. It also ranked the highest in terms of Distant Metastasis-Free Survival (DMFS), with a SUCRA score of 85.90 %. Additionally, the CCRT + anti-EGFR combination therapy ranked the highest in terms of PFS, with a SUCRA score of 77.21 %, while the IC + RT combination had the fewest Adverse Effects (AEs) (3-4 grade), with a SUCRA score of 86.20 %.

Conclusion: The IC + CCRT + AC + anti-EGFR combination therapy significantly improved OS, DMFS, and LRFS, highlighting its great promise in LA-NPC treatment. However, owing to the relatively few studies on immunotherapy and targeted therapy, more well-designed studies will be required to validate this deduction.

Keywords: Concurrent chemoradiotherapy; Induction chemotherapy; Locally Advanced Nasopharyngeal Carcinoma; Optimal treatment strategy; Targeted therapy.