Abstract
Concurrent chemoradiotherapy (CCRT) has been considered to be the standard of care for locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). Whether induction chemotherapy (IC) with CCRT will further improve the clinical outcomes or not is still unclear. We conducted a meta-analysis to compare the two regimens for LA-SCCHN. Literature searches were carried out in PubMed, Embase, Cochrane Library and Chinese Biology Medicine from inception to November 2014. Five prospective randomized controlled trials (RCTs) with 922 patients were included in meta-analysis. Results were expressed as hazard ratios (HRs) or relative risks (RRs) with 95% confidence intervals (CIs). Compared with CCRT, IC with CCRT showed no statistically significant differences in overall survival (OS), progression-free survival (PFS), overall response rate (ORR) or locoregional recurrence rate (LRR), but could increase risks of grade 3–4 febrile neutropenia (P = 0.0009) and leukopenia (P = 0.04). In contrast, distant metastasis rate (DMR) decreased (P = 0.006) and complete response rate (CR) improved (P = 0.010) for IC with CCRT. In conclusion, the current studies do not support the use of IC with CCRT over CCRT, and the further positioning of IC with CCRT as standard treatment for LA-SCCHN will come from more RCTs directly comparing IC followed by CCRT with CCRT.
Highlights
Concurrent chemoradiotherapy (CCRT) has been considered to be the standard of care for locally advanced squamous cell carcinoma of head and neck (LA-SCCHN)
We present a meta-analysis to evaluate the efficacy and toxicity of induction chemotherapy (IC) followed by CCRT versus CCRT alone in the treatment of LA-SCCHN
181 abstracts were selected for further evaluation, of which 164 trials were excluded because these were reviews, case reports, meeting abstracts or subjects and interventions were not related to our study
Summary
181 abstracts were selected for further evaluation, of which 164 trials were excluded because these were reviews, case reports, meeting abstracts or subjects and interventions were not related to our study. After review of the full texts, five prospective randomized controlled trials (RCTs) met the inclusion criteria and were included in meta-analysis[18,19,20,21,22]. Every trial reported hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) and/or progression-free survival (PFS), or data to calculate these. These trials were published between 2010 and 2014. All trials provided data on the mean/median age of patients, Study Paccagnella A et al (2010)[18]
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