Abstract
Objective The benefits of accelerated hyperfractionated radiotherapy (HART) and conventional fractionation radiotherapy (CFRT) in the treatment of head and neck cancer (HNC) remain controversial. In this study, we analyzed the therapeutic effects of these two treatment regimens to explore whether HART can improve the overall survival (OS) rate and locoregional control (LRC) rate in patients with HNC. Methods The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible studies. The OS rate and LRC rate were considered as the efficacy outcomes. I2 was used to test the heterogeneity among studies with a cutoff value of 50%. Potential publication bias was assessed by funnel plots and Egger's test. We also performed a sensitivity analysis to assess the stability of the results. In this meta-analysis, all analyses were performed using R 3.5.3 software. Results Twelve qualified articles including a total of 2,935 patients were identified. HART had a significant beneficial effect on OS rate (HR = 0.80, 95% CI: 0.65–0.98). Compared with CFRT, HART demonstrated a significantly higher LRC rate (HR = 0.82, 95% CI: 0.71–0.96). Conclusion Our meta-analysis showed that HART can significantly improve OS and LRC compared with CFRT in patients with HNC.
Highlights
Head and neck cancer (HNC) is one of the most common types of cancer, with estimated more than 600,000 new cases each year and more than 300,000 deaths all over the world [1, 2]
There were several high-quality papers [9, 10] which showed that hyperfractionated radiotherapy (HART) was superior to conventional fractionation radiotherapy (CFRT), some studies [11, 12] have found that HART was not better than CFRT. erefore, we performed a meta-analysis to investigate the prognostic effect of HART and CFRT for HNC. e main purpose was to study the effect of HARTand CFRT on the overall survival (OS) rate and locoregional control (LRC) rate to provide guidance for a reasonable clinical practice
We found that the results for OS rate (Figure 4(a)) and LRC rate (Figure 4(b)) may not be stable. e funnel plots of OS rate and LRC rate are shown in Figure 5. e funnel plots were symmetrically distributed, and Egger’s test was used to assess publication bias (OS: P value 0.058, LRC: P value 0.098). ere was no publication bias found using these indicators
Summary
Head and neck cancer (HNC) is one of the most common types of cancer, with estimated more than 600,000 new cases (including cancer of the oral cavity, oropharynx, hypopharynx, and larynx) each year and more than 300,000 deaths all over the world [1, 2]. Since the 1980s, unconventional fractionation therapy methods have been developed, and new treatment options for HNC have been tested several times [5]. E differences between various types of unconventional fractionation radiation depend on their dose of radiation, the number of radiation session, and the total duration of radiotherapy. Accelerated hyperfractionated radiotherapy (HART) is a Journal of Oncology common treatment among the unconventional fractionation therapy options [6]. E HART plan has more daily radiotherapy times and treatment doses than the CFRT plan does [7]. In some randomized controlled trials, the frequency of treatment per day for HART was more than that for CFRT, the average dose per fractionation was greater than that of CFRT, and the average total time was less than that of CFRT. There were several high-quality papers [9, 10] which showed that HART was superior to CFRT, some studies [11, 12] have found that HART was not better than CFRT. erefore, we performed a meta-analysis to investigate the prognostic effect of HART and CFRT for HNC. e main purpose was to study the effect of HARTand CFRT on the OS rate and locoregional control (LRC) rate to provide guidance for a reasonable clinical practice
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