Intervention Review

Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma

  1. Bertrand Baujat1,*,
  2. Hélène Audry2,
  3. Jean Bourhis3,
  4. Anthony TC Chan4,
  5. Haluk Onat5,
  6. Daniel TT Chua6,
  7. Dora LW Kwong6,
  8. Muhyi Al-Sarraf7,
  9. Kwan-Hwa Chi8,
  10. Masato Hareyama9,
  11. Singh F Leung4,
  12. Kullathorn Thephamongkhol10,
  13. Jean Pierre Pignon11,
  14. MAC-NPC Collaborative Group1

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 22 AUG 2006

DOI: 10.1002/14651858.CD004329.pub2

How to Cite

Baujat B, Audry H, Bourhis J, Chan ATC, Onat H, Chua DTT, Kwong DLW, Al-Sarraf M, Chi KH, Hareyama M, Leung SF, Thephamongkhol K, Pignon JP, MAC-NPC Collaborative Group. Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004329. DOI: 10.1002/14651858.CD004329.pub2.

Author Information

  1. 1

    Hôpital Foch, Head and Neck Surgery, Suresnes, France

  2. 2

    Institut Gustave-Roussy, Biostatistique et Epidémiologie, 94805 Villejuif Cedex, France

  3. 3

    Institut Gustave-Roussy, Département de Radiothérapie, 94805 Villejuif Cedex, France

  4. 4

    Prince of Wales Hospital, Clinical Oncology, Shatin, NT, Hong Kong

  5. 5

    Istanbul University, Institute of Oncology, Istanbul, Turkey

  6. 6

    Queen Mary Hospital, Clinical Oncology, Hong Kong Island, Hong Kong

  7. 7

    Wayne State University, Department of Internal Medicine, Detroit, Michigan, USA

  8. 8

    Taiwan Co-operative Oncology Group, Taipei, Taiwan

  9. 9

    Sapporo Medical University, Radiology, Sapporo, Japan

  10. 10

    Faculty of Medicine Siriraj Hospital Mahidol University, Div of Radiation Oncology Department of Radiology, Bangkok, Thailand

  11. 11

    Institut Gustave-Roussy, Service de Biostatistique et d'Epidemiologie, Villejuif Cedex, France

*Bertrand Baujat, Head and Neck Surgery, Hôpital Foch, 40 rue Worth, Suresnes, 92150, France.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006




  1. Top of page
  2. Abstract
  3. Plain language summary


A previous meta-analysis investigated the role of chemotherapy in head and neck locally advanced carcinoma. This work had not been performed on nasopharyngeal carcinoma.


The aim of the project was to study the effect of adding chemotherapy to radiotherapy on overall survival (OS) and event-free survival (EFS) in patients with nasopharyngeal carcinoma.

Search methods

We searched MEDLINE (1966 to October 2003), EMBASE (1980 to October 2003) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2003) and trial registers. Handsearches of meeting abstracts, references in review articles and of the Chinese medical literature were carried out. Experts and pharmaceutical companies were asked to identify trials.

Selection criteria

Randomised trials comparing chemotherapy plus radiotherapy to radiotherapy alone in locally advanced nasopharyngeal carcinoma were included.

Data collection and analysis

The meta-analysis was based on updated individual patient data. The log rank test, stratified by trial, was used for comparisons and the hazard ratios (HR) of death and failure (loco-regional/distant failure or death) were calculated.

Main results

Eight trials with 1753 patients were included. One trial with a 2 x 2 design was counted twice in the analysis. The analysis was performed including 11 comparisons based on 1975 patients. The median follow up was six years. The pooled hazard ratio of death was 0.82 (95% confidence interval (CI) 0.71 to 0.95; P = 0.006) corresponding to an absolute survival benefit of 6% at five years from chemotherapy (from 56% to 62%). The pooled hazard ratio of tumour failure or death was 0.76 (95% CI 0.67 to 0.86; P < 0.00001) corresponding to an absolute event-free survival benefit of 10% at five years from chemotherapy (from 42% to 52%). A significant interaction was observed between chemotherapy timings and overall survival (P = 0.005), explaining the heterogeneity observed in the treatment effect (P = 0.03) with the highest benefit from concomitant chemotherapy.

Authors' conclusions

Chemotherapy led to a small but significant benefit for overall survival and event-free survival. This benefit was essentially observed when chemotherapy was administered concomitantly with radiotherapy.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma

Eight trials (1753 patients) met the criteria for inclusion in this review. The addition of chemotherapy to standard radiotherapy provides a small but significant benefit in patients with nasopharyngeal cancer, especially when chemotherapy is administered at the same time as radiotherapy. The role of chemotherapy given before or after the radiotherapy is more questionable.