Postoperative adjuvant chemoradiotherapy versus radiotherapy alone for head and neck squamous cell carcinoma: A meta-analysis evaluating the role of chemotherapy schedules.

Abstract

5583 Background: To compare concurrent post-operative chemoradiotherapy (POCRT) with post operative radiotherapy alone (PORT) for head and neck squamous cell carcinoma (HNSCC), evaluating different chemotherapy regimens used. Methods: A meta-analysis of RCT was performed comparing POCRT to PORT for HNSCC. The MEDLINE, EMBASE, and Cochrane Library databases, as well as abstracts published in the annual proceedings were systematically searched. We assessed methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment. Results: Pooled results from 8 randomized trials (1,808 patients) evaluating POCRT (3 trials using cisplatin alone, 2 mitomycin –c, 2 carboplatin and 1 cisplatin + 5-FU) in HNSCC showed significant decreased of mortality (OR=0.68, CI95%-0.52, 0.86, p<0.0001) as compared to PORT. In the subgroup analysis cisplatin alone was the only chemotherapy schedule that showed a reduction in overall mortality rate when compared to PORT (OR=0.62, CI95%-0.47, 0.82, p=0.0008). There was significant difference for local recurrence among those patients receiving PORCT and PORT (OR=0.46, CI 95% 0.37-0.58, p<0.0001). In the subgroup analysis the carboplatin schedule was the only subgroup that there was not any difference for local recurrence rates when compared to PORT (OR=0.72, CI 95% 0.46-1.13, p=0.25). Conclusions: Our data demonstrate that adjuvant cisplatin-enhanced radiation therapy is more effective than PORT for high-risk tumors in terms of locoregional control and survival, when compared to other regimens. Results of the present study failed to demonstrate that the addition of carboplatin to PORT provides a statistically significant benefit in terms of local control and survival rate. No significant financial relationships to disclose.