Comparative study of three treatment approaches on overall survival and treatment response in nasopharyngeal carcinoma patients: network meta-analysis of RCTs (4221 patients)

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• Picked for Oncology and Radiation Oncology (top studies of the week, 19 July 2026): Network meta‑analysis of induction, targeted, radiotherapy for nasopharyngeal carcinoma

Abstract

OBJECTIVE: Nasopharyngeal carcinoma (NPC) is a malignant tumor with significant disease burden. Currently, radiotherapy-based multimodal therapy remains the primary treatment strategy for NPC, yet consensus on the relative efficacy of induction chemotherapy, targeted therapy, and radiotherapy remains elusive. This study aims to systematically compare the relative efficacy of induction chemotherapy, targeted therapy, and radiotherapy on overall survival and treatment response using network meta-analysis, thereby providing evidence-based guidance for clinical decision-making. METHODS: Following the PRISMA-NMA and Cochrane Manual guidelines, we systematically searched six databases (PubMed, Embase, Web of Science, Cochrane Library, EBSCO, and CNKI) for relevant randomized controlled trials (RCTs) published between January 1998 and June 2025. Two researchers independently conducted literature screening, data extraction, and risk of bias assessment. A total of 12 randomized controlled trials were ultimately included. Traditional meta-analysis and heterogeneity assessment were performed using RevMan 5.3 software. A network meta-analysis was conducted using STATA 17.0 software (Stata Corp LLC, College Station, TX, USA) based on a frequency framework, with interventions ranked by cumulative ranked probability area under the curve (SUCRA). Publication bias was evaluated using a corrected funnel plot. RESULTS: Network meta-analysis showed that while TD ranked first in the probability of being the best treatment for OS (SUCRA = 98.1%), only IC demonstrated a statistically significant survival benefit compared to the control group (HR = 0.37, 95% CI: 0.02, 0.71). Regarding PFS, TD ranked first (SUCRA = 82.2%, HR = -0.68, 95% CI: -2.59, 1.23), although no intervention demonstrated a statistically significant benefit compared to the control group. In terms of ORR, IC had the highest probability (SUCRA = 71.6%, OR = 0.24, 95% CI: -2.18, 2.66), with no statistically significant differences among the interventions. Regarding CRR, TD showed the greatest advantage (SUCRA = 98.0%, OR = 0.26, 95% CI: 0.12, 0.58). CONCLUSION: The network meta-analysis results indicate that induction chemotherapy offers the greatest advantage in improving overall survival for nasopharyngeal carcinoma patients, while targeted drugs perform best in reducing cumulative recurrence risk. No statistically significant differences were observed among the three interventions for progression-free survival or objective response rate. Radiotherapy alone did not demonstrate significant benefit across any outcome measures. This study provides important evidence-based support for individualized treatment decisions in nasopharyngeal carcinoma. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251178558.

Abstract as published, via PubMed.