Abstract
BackgroundHypopharyngeal and laryngeal neoplasms are both fatal and hard to catch in early stages. Yet which treatment is the most efficacious one still remain unanswered. This network meta-analysis (NMA) was conducted to investigate effectiveness of six therapies being utilized in clinical practice nowadays.MethodsPubMed and Embase were retrieved to synthesize data. Direct and indirect evidence was combined to compare efficacy of treatments. A relative ranking of the six regimens was calculated by the surface under the curve ranking area (SUCRA).ResultsA total of 28 trials with 9109 patients were included in our NMA. Five endpoints investigated included 3/5-year overall survival (3/5-OS), 3/5-year disease free survival (3/5-DFS) and 5-year overall survival rate (5-OSR). In terms of all efficacy outcomes, radiotherapy combined with surgery (RT + S) proved to be better than other therapies while radiotherapy (RT) alone also performed well. Induction chemoradiotherapy (ICRT) was the best regarding 3-DFS (SUCRA = 0.846) while current chemoradiotherapy (CCRT) ranked first in 5-DFS (SUCRA = 0.933) according to SUCRA results. No significant differences were demonstrated in 5-DFS and 5-OSR as shown in the results of NMA.ConclusionsRT combined with surgery turned out to be optimal therapy of all the outcomes while the efficacy of RT was relatively poorer in the treatment of patients with larynx stage III-IV and hypopharynx stage II-IV. Also, the good performance of CCRT and ICRT in terms of DFS made them as secondary recommended therapies. There is no significant difference between surgery and transoral laser microsurgery (TLM) alone.
Highlights
Hypopharyngeal and laryngeal neoplasms are both fatal and hard to catch in early stages
Subject terms and key words including “hypopharyngeal neoplasms”, “laryngeal neoplasms”, “radiotherapy”, “chemoradiotherapy”, “transoral laser microsurgery”, “radiotherapy combined with surgery”, “induction chemotherapy radiotherapy”, “current chemotherapy radiotherapy”, and “clinical controlled trials” were searched with Boolean operators OR and AND
Inclusion and exclusion criteria Included studies were restricted by the following criteria: (1) the study was clinical controlled trial; (2) patients were diagnosed with hypopharyngeal neoplasms or laryngeal neoplasms; (3) therapies included at least one of the six following treatments: surgery, radiation therapy (RT), transoral laser microsurgery (TLM), radiotherapy combined with surgery (RT + S), induction chemotherapy radiotherapy (ICRT), and current chemotherapy radiotherapy (CCRT); (4) at least one of the following relevant outcomes was provided: 3/5-year overall survival (3/5-OS), 3/5-year disease free survival (3/5-DFS) and 5-year overall survival rate (5-OSR)
Summary
Hypopharyngeal and laryngeal neoplasms are both fatal and hard to catch in early stages. Which treatment is the most efficacious one still remain unanswered This network meta-analysis (NMA) was conducted to investigate effectiveness of six therapies being utilized in clinical practice nowadays. Multiple treatments for hypopharyngeal or laryngeal neoplasms have been developed and compared, which include surgery, radiation therapy (RT), chemoradiation therapy (CRT), or kinds of combination of treatments aforementioned [3]. One of the main targets of treating patients with locoregional advanced laryngeal cancer is to maintain larynx function. RT and CT being applied separately or combined have triggered worries regarding a decrease in overall survival rate (OSR) since they are reckoned to have caused acute toxicity and disrupted laryngeal function [4]
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