Updated Meta-Analysis Confirms Survival Benefit of Adding Chemotherapy to Radiotherapy in Nasopharyngeal Cancer


Key Points

  • The addition of chemotherapy to radiotherapy was associated with significantly improved overall survival in patients with nasopharyngeal carcinoma.
  • The survival benefit was greatest with concomitant therapy.

In an updated patient-level meta-analysis reported in The Lancet Oncology, Blanchard et al of the Meta-Analysis of Chemotherapy in Nasopharyngeal Carcinoma (MAC-NPC) collaborative group found that the addition of chemotherapy to radiotherapy improved overall survival in patients with nasopharyngeal carcinoma, with the greatest benefit being observed with concomitant administration.

Improved Survival

The meta-analysis included data from 19 trials and 4,806 patients, with a median follow-up of 7.7 years. The addition of chemotherapy to radiotherapy was associated with a significant improvement in overall survival (hazard ratio [HR] = 0.79, P < .0001), with a 5-year absolute benefit of 6.3% (95% confidence interval [CI] = 3.5%–9.1%). The interaction between benefit of chemotherapy for overall survival and timing of chemotherapy was significant (P = .01) for concomitant chemotherapy and radiotherapy plus adjuvant chemotherapy (HR = 0.65, 95% CI = 0.56–0.76) and concomitant treatment without adjuvant chemotherapy (HR = 0.80, 95% CI = 0.70–0.93) but not for adjuvant chemotherapy alone (HR = 0.87, 95% CI = 0.68–1.12) or induction chemotherapy alone (HR = 0.96, 95% CI = 0.80–1.16).

Other Outcomes

The addition of chemotherapy to radiotherapy was associated with significant improvement (all P < .0001) in progression-free survival (HR = 0.75, 95% CI = 0.69–0.81), locoregional control (HR = 0.73, 95% CI = 0.64–0.83), distant control (HR = 0.67, 95% CI = 0.59–0.75), and cancer mortality (HR = 0.76, 95% CI = 0.69–0.84).

The investigators concluded: “Our results confirm that the addition of concomitant chemotherapy to radiotherapy significantly improves survival in patients with locoregionally advanced nasopharyngeal carcinoma. To our knowledge, this is the first analysis that examines the effect of concomitant chemotherapy with and without adjuvant chemotherapy as distinct groups. Further studies on the specific benefits of adjuvant chemotherapy after concomitant chemoradiotherapy are needed.”

Jean-Pierre Pignon, MD, of Institut Gustave Roussy, is the corresponding author of The Lancet Oncology article.

The study was funded by the French Ministry of Health (Programme d’actions intégrées de recherche VADS), Ligue Nationale Contre le Cancer, and Sanofi-Aventis. For full disclosures of the study authors, visit

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