A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC)

Jian Guan, Yue Zhang, Qinyang Li, Yaowei Zhang, Lu Li, Min Chen, Nanjie Xiao, Longhua Chen, Jian Guan, Yue Zhang, Qinyang Li, Yaowei Zhang, Lu Li, Min Chen, Nanjie Xiao, Longhua Chen

Abstract

Purpose: This study was performed to compare the efficacies and acute toxicities in weekly- and three weekly- cisplatin based concurrent chemoradiotherapy (CCRT) for advanced HNC patients.

Results: 779 patients of 10 studies were eligible. No difference in the 2-, 3-year OS or 1-, 2-year LRFS was observed, whereas patients in three weekly CCRT arm tended to have a better 5-year OS (HR=1.79, 95%C 0.97-3.31, p=0.06). Weekly arm seemed to show less gastrointestinal toxicities (RR=0.59, 95%CI 0.34-1.02, p=0.06), but similar hematologic toxicity compared to three weekly arm. Subgroup analysis displayed more grade ≥3 mucositis (RR=1.72, p=0.01), and more chemotherapy related delay/interrupt (RR=2.68, p<0.0001) in weekly arm for non-nasopharynx carcinoma (non-NPC) HNC.

Methods: We conducted the meta-analysis by searching PubMed, MEDLINE, ScienceDirect, Cochrane Library and China National Knowledge Infrastructure (CNKI) databases. The primary endpoint was overall survival (OS) with secondary endpoints locoregional recurrence-free survival (LRFS) and grade≥3 acute adverse events. RevMan 5.2 was used to perform statistical analyses.

Conclusions: Three weekly cisplatin-based CCRT might achieve a higher long-term OS with no significant difference in a shorter OS and LRFS. Weekly arm was associated with less gastrointestinal toxicities but more grade≥3 mucositis and chemotherapy related delay/interrupt. Large randomized trials were urgent to further define superiority of these two regimens.

Keywords: cancer; cisplatin; head and neck; meta-analysis; therapy.

Conflict of interest statement

CONFLICTS OF INTEREST

There authors report no other conflicts of interest.

Figures

Figure 1. Study selection flow about the…
Figure 1. Study selection flow about the cisplatin-based chemoradiotherapy of head and neck cancer
CNKI = China National Knowledge Infrastructure.
Figure 2. Forest plots of hazard ratios…
Figure 2. Forest plots of hazard ratios for 2-year, 3-year and 5-year OS in patients between weekly and three weekly cisplatin chemoradiotherapy
OS=overall survival. CI=confidence interval, I2=index of heterogeneity.
Figure 3. Forest plots of hazard ratios…
Figure 3. Forest plots of hazard ratios for 1-year and 2-year LRFS in patients between weekly and three weekly cisplatin chemoradiotherapy
LRFS=Locoregional recurrence-free survival. CI=confidence interval, I2=index of heterogeneity.
Figure 4. Weekly versus three weekly cisplatin…
Figure 4. Weekly versus three weekly cisplatin chemoradiotherapy with toxicity grade ≥3 mucositis
CI=confidence interval, I2=index of heterogeneity.
Figure 5. Weekly versus three weekly cisplatin…
Figure 5. Weekly versus three weekly cisplatin chemoradiotherapy in delays or interruption of treatment
CI=confidence interval, I2=index of heterogeneity.

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