Chemoradiotherapy regimens for locoregionally advanced nasopharyngeal carcinoma: A Bayesian network meta-analysis.
Bibliographic record
Abstract
6024 Background: Concurrent chemoradiotherapy followed by adjuvant chemotherapy (CRT-A) is often the regimen of choice in locoregionally advanced nasopharyngeal carcinoma (LANPC). Many alternative regimens have been reported in the literature; however, it is unknown how effective these regimens are compared to each other due to the lack of direct comparisons. Our aim was to perform a network meta-analysis (NMA) to determine the relative survival benefits of these treatments in LANPC. Methods: We performed a systematic review following the Cochrane methodology, using MEDLINE, EMBASE, and CENTRAL to identify all randomized controlled trials (RCTs) that compared different chemoradiotherapy regimens in LANPC. Overall survival (OS) and progression-free survival (PFS) were the primary outcomes of interest. Hazard ratios (HRs) were extracted using the Parmar method. Bayesian NMAs with random effects were conducted using WinBUGS to compare all regimens simultaneously and improve precision. Results: Twenty-four RCTs (5,492 patients) were included in this review. All together, these trials compared seven different regimens: radiotherapy (RT), concurrent chemoradiotherapy (CRT), neoadjuvant followed by CRT (N-CRT), CRT-A, RT-A, N-RT and N-RT-A. All regimens that contained CRT performed significantly better than RT. The combined HRs for CRT-A vs. CRT were 0.96 (95% credible regions: 0.69–1.31) for OS and 0.86 (0.55–1.39) for PFS. For N-CRT vs. CRT, the HRs were 1.01 (0.65–1.46) for OS and 0.65 (0.34–1.18) for PFS. When CRT-A was compared against N-CRT, the resulting HRs were 0.96 (0.64–1.46) for OS and 1.33 (0.67–2.87) for PFS. CRT, CRT-A and N-CRT all had similar probabilities of being the best regimen (23%, 34% and 28% respectively) among all seven regimens based on OS. Conclusions: To our knowledge, this is the first NMA to study chemoradiotherapy regimens in LANPC. Contrary to common clinical practice, adjuvant chemotherapy does not appear to improve survival following CRT. The efficacies of CRT, CRT-A and N-CRT all appeared to be similar. Further studies are warranted to examine whether omitting additional chemotherapy phases can decrease side effects without adversely affecting survival.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.045 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.013 | 0.051 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".