Hyperthermia Combined with Radiotherapy or Radio-Chemotherapy for Primary Nasopharyngeal Cancer: A Systematic Review

Objective To evaluate the clinical efficacy and safety of hyperthermia combined with radiotherapy or radio-chemotherapy in treating primary nasopharyngeal cancer, and to provide references for clinical practice and research. Methods We searched foreign databases such as Cochrane Library, PubMed, EMBASE, Web of Science and Chinese ones including CBM, CNKI, VIP and WanFang with computer. In addition, we also retrieved other sources for supplying. All relevant randomized controlled trials （RCTs） were collected to compare hyperthermia combination therapy with radio-chemotherapy or radiotherapy alone. After literature screening, data extraction and quality evaluation were performed in accordance with the criteria of Cochrane handbook, the meta-analysis was conducted using RevMan 5.1 software. Results Twenty-one RCTs were selected with 1 680 patients included. Meta-analysis showed: ① The treatment group underwent radiotherapy plus intracavity hyperthermia for nasopharyngeal cancer. The complete response and total effective rate of treatment group were both higher than the control group with radiotherapy alone, the OR value and 95%CI were 3.13, （2.00,4.92） and 6.84, （1.48,31.60）, respectively, and the differences between the two groups showed statistical significance （P<0.05）; ② The treatment group underwent hyperthermo-radiotherapy for cervical lymph node metastasis from nasopharyngeal cancer. The complete response and total effective rate of treatment group were both higher than the control group with radiotherapy alone, the OR value and 95%CI were 3.89, （2.26,6.71） and 6.96, （2.15,22.48）, respectively, and the differences between the two groups showed statistical significance（P<0.05）; ③ The treatment group underwent hyperthermo-radio-chemotherapy for cervical lymph node metastasis from nasopharyngeal cancer. The complete response and total effective rate, 3-5-year survival rate, 5-year local control and progression free survival rate, these in the treatment group were all superior to radio-chemotherapy alone group, the OR value and 95%CI were 3.02, （2.12,4.29）, 5.02, （1.64,15.33）, 2.81, （1.82,4.34）, 2.00, （1.34,2.99）, 4.05, （2.55,6.43）, and 8.70, （3.59,21.12）, respectively, and the differences between the two groups were of statistical significance （P<0.05）. Conclusion Compared with radio-chemotherapy or radiotherapy alone, hyperthermia combination therapy for nasopharyngeal cancer and cervical lymph node metastasis can improve long-term survival rate or short-term curative effect. Additionally, it is safe and feasible. However, its long-term survival rate and safety still need to be further verified by more large sample and high quality RCTs.