Journal of Cancer Research and Therapeutics

ORIGINAL ARTICLE
Year
: 2015  |  Volume : 11  |  Issue : 6  |  Page : 222--225

Metronidazole amino acidum natrium combined with radiation in the treatment of nasopharyngeal carcinoma: A meta-analysis based on randomized controlled trials


Shengli Wei, Yizhuo Xing, Jixiang Liu, Lin Wang, Xiangli Yang, Fucun Song, Chunwei Yang, Lin Niu, Yang Yang, Fei Wu 
 Department of Otolaryngology, Head and Neck Surgery, Tianjin Union Medicine Centre, Tianjin 300000, PR, China

Correspondence Address:
Shengli Wei
Department of Otolaryngology, Head and Neck Surgery, Tianjin Union Medicine Centre, Tianjin 300000
China

Abstract

Objective: We performed this meta-analysis to assess the metronidazole amino acidum natrium combined with radiation in the treatment of nasopharyngeal carcinoma. Materials and Methods: Two reviewers independently reviewed the databases of PubMed and CNKI. The prospective, randomized, controlled trials of metronidazole amino acidum natrium combined with radiation versus radiotherapy alone in the treatment of nasopharyngeal carcinoma were included in this meta-analysis. The objective response rate (RR) of 1-, 3-, and 5-year survival rates were pooled by statistical software. The publication bias was evaluated by Begg's funnel plot. Results: Sixteen prospective, randomized, controlled trials were finally included in this meta-analysis. The quality assessment showed that the method's quality was relatively poor. The pooled results showed that the metronidazole amino acidum natrium combined with radiation can significantly improve the objective RR for the primary lesion (RR = 1.37, 95% confidence interval [CI]: 1.23–1.53, P < 0.05) and neck metastasis lesion (RR = 1.36, 95% CI: 1.25–1.49, P < 0.05). For survival analysis, the combined treatment can significantly improve the 1-year survival (RR = 1.57, 95% CI: 1.28–1.93, P < 0.05), 3-year survival (RR = 1.23, 95% CI: 1.06–1.41, P < 0.05), and 5-year survival rates (RR = 1.27, 95% CI: 1.05–1.53, P < 0.05). Conclusion: Metronidazole amino acidum natrium combined with radiation can improve the objective RR and long-term survival compared to radiation therapy alone in the treatment of nasopharyngeal carcinoma.



How to cite this article:
Wei S, Xing Y, Liu J, Wang L, Yang X, Song F, Yang C, Niu L, Yang Y, Wu F. Metronidazole amino acidum natrium combined with radiation in the treatment of nasopharyngeal carcinoma: A meta-analysis based on randomized controlled trials.J Can Res Ther 2015;11:222-225


How to cite this URL:
Wei S, Xing Y, Liu J, Wang L, Yang X, Song F, Yang C, Niu L, Yang Y, Wu F. Metronidazole amino acidum natrium combined with radiation in the treatment of nasopharyngeal carcinoma: A meta-analysis based on randomized controlled trials. J Can Res Ther [serial online] 2015 [cited 2021 Oct 27 ];11:222-225
Available from: https://www.cancerjournal.net/text.asp?2015/11/6/222/168190


Full Text

 Introduction



It was reported that about 60–70% of nasopharyngeal carcinoma was at the advanced stage during the diagnosis.[1] The treatment modality for the advanced or metastasis stage patients was, generally, radiation. However, the average 5-year overall survival rate for radiotherapy was only 30–50%.[2] The main reason for treatment failure was local recurrence or remote metastasis. Hence, how to improve the radiation efficacy and prolong the 5-year survival is important for nasopharyngeal carcinoma treatment.

Recently, several studies have demonstrated that the metronidazole amino acidum natrium combined radiotherapy can improve the prognosis of nasopharyngeal carcinoma. Metronidazole amino acidum natrium is a kind of drug that was developed in China, which could be used as the radiotherapy sensitization agent. It had been proved that the metronidazole amino acidum can improve the radiation effects in patients with nonsmall cell lung cancer.[3] However, the radiotherapy sensitization effects in the patients of nasopharyngeal carcinoma was not conclusive. Thus, we perform this meta-analysis by pooling the open published, prospective, randomized controlled trials in order to assess the efficacy of metronidazole amino acidum natrium combined with radiation in the treatment of nasopharyngeal carcinoma.

 Materials and Methods



Two reviewers (Shengli Wei and Yizhuo Xing) independently reviewed the databases of PubMed and CNKI. The prospective, randomized, controlled trials of metronidazole amino acidum natrium combined with radiation versus radiotherapy alone in the treatment of nasopharyngeal carcinoma were included in this meta-analysis. The inclusion criteria of the studies were: (1) The study type was prospective, randomized controlled trials; (2) the patients who were diagnosed of nasopharyngeal carcinoma; (3) the treatment method was metronidazole amino acidum natrium combined with radiation versus radiotherapy alone (4) the outcomes were objective response rate (RR) and survival. The data for each individual study were extracted by two reviewers (Jixiang Liu and Lin Wang) and checked by the third reviewer (Xiangli Yang).

Statistical analysis

In this meta-analysis, we used the statistical software Stata version 10.0 (http://www.stata.com; Stata Co., College Station, TX, USA) to do all the data analysis. The data were pooled by random or fixed effect model according to the heterogeneity across the included studies. The publication was evaluated by Begg's funnel plot and Egger's line regression test. Two-tailed P < 0.05 was deemed as statistical significance.

 Results



General characteristics

Sixteen prospective, randomized controlled trials [4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19] were finally included in this meta-analysis. All of the studies are published in Chinese. The publication year ranges from 2006 to 2102. The methodology assessment showed that 5 studies mentioned the adequate sequence generation, 2 articles using the allocation concealment, only 1 study mentioned the blinding method, 9 trials mentioned the incomplete outcome data address, and

6 studies reported the free of selecting reporting. The general quality of the included 16 studies was relative poor [Figure 1].{Figure 1}

Treatment efficacy

Ten studies reported the objective RR between metronidazole amino acidum natrium combined with radiation and radiotherapy alone. The pooled results showed that the metronidazole amino acidum natrium combined with radiation can significant improve the objective RR for the primary lesion (RR = 1.37, 95% confidence interval [CI]: 1.23–1.53, P < 0.05) and neck metastasis lesion (RR = 1.36, 95% CI: 1.25–1.49, P < 0.05) [Figure 2].{Figure 2}

Survival analysis

Three articles reported the 1-year survival, 2 articles reported the 3- and 5-year survival in the combined and radiation therapy alone. The pooled data showed that the combined treatment can significantly improve the 1-year survival (RR = 1.57, 95% CI: 1.28–1.93, P < 0.05), 3-year survival (RR = 1.23, 95% CI: 1.06–1.41, P < 0.05), and 5-year survival rates (RR = 1.27, 95% CI: 1.05–1.53, P < 0.05) [Figure 3].{Figure 3}

Publication bias

The publication bias was evaluated by Begg's funnel plot and Egger's line regression test. For an objective response, the funnel plot was asymmetrical [Figure 4] and Egger's test indicated obvious publication bias (P < 0.05). For survival analysis, the Begg's funnel [Figure 5] and Egger's line regression test also indicated significant publication bias (P < 0.05).{Figure 4}{Figure 5}

 Discussion



In this meta-analysis, we finally included 16 prospective, randomized controlled trials. All of the included trials are published in Chinese. We evaluated the quality of the included studies according to Cochrane Handbook.[20] The methodology assessment showed that 5 studies mentioned the adequate sequence generation, 2 articles using the allocation concealment, only 1 study mentioned the blinding method, 9 trials mentioned the incomplete outcome data address, and 6 studies reported the free of selecting reporting. Generally speaking, the quality of the included 16 studies was relatively poor. The poor individual study quality made the results limited.

We pooled the objective RR and survival according to the individual data. The pooled results showed that the metronidazole amino acidum natrium combined with radiation can significantly improve the objective RR for the primary lesion and neck metastasis lesion. The results indicated that the short-term response could be significantly improved by adding the metronidazole amino acidum natrium in the radiation procedure. Moreover, for survival analysis, metronidazole amino acidum natrium combined with radiation can significantly improve the 1-, 3-, and 5-year survival rates. This indicated that the long-term survival could also be improved by the combined treatment.

Although the metronidazole amino acidum natrium combined with radiation can improve the objective response rate and long-term survival compared to radiation therapy alone. However, some limitations were also existed in this meta-analysis: (1) The methodology quality of the included 16 trials was relative poor; (2) all of the studies were came from China with publication language of Chinese; (3) the patients' number in each individual study was relatively small; (4) the drug-related toxicities were not evaluated in this meta-analysis; (5) significant publication bias was found in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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