title: Clinical efficacy of neoadjuvant chemotherapy with platinum-based regimen for patients with locoregionally advanced head and neck squamous cell carcinoma: an evidence-based meta-analysis.
abstract: OBJECTIVE
  As a vital chemotherapeutic modality, the clinical benefits of neoadjuvant chemotherapy still remain uncertain and controversial. The purpose of this meta-analysis was to evaluate the efficacy of neoadjuvant chemotherapy with a platinum-based regimen for patients with locoregional stage III or IV squamous cell carcinoma of the head and neck.
  
  
  METHODS
  Meta-analysis of randomized, controlled trials.
  
  
  METHODS
  Relevant randomized controlled trials (RCTs) were identified through systematic search and selected according to the inclusion and exclusion criteria. Eligible RCTs were further analyzed by systematic meta-analysis. Statistical analysis was performed by Review Manager 5.0.21.0 software.
  
  
  RESULTS
  A total of 6 RCTs were identified. Pooling effects revealed that there was no statistical significance in locoregional recurrence [relative risk (RR)= 1.06; 95% CI (confidence interval= 0.91-1.24; P>.05], distant metastasis (RR= 0.6; 95% CI= 0.28-1.30; P>.05), disease-free survival (RR= 0.93; 95% CI= 0.75-1.15; P>.05) or overall survival (RR= 0.98; 95% CI= 0.89-1.09; P>.05). More of the common hematological adverse effects were reported with a cisplatin-based regimen. All the studies analyzed in this meta-analysis were individual RCTs with adequate follow-up and relatively narrow confidence intervals, which were classified to the 1b level, and this meta-analysis was classified to the 1a level, according to the Levels of Evidence (March 2009) of Oxford Center for Evidence-based Medicine.
  
  
  CONCLUSIONS
  The meta-analysis indicates there is a non-significant difference between neoadjuvant chemotherapeutic treatment and conventional locoregional modality for patients at high risk of recurrence, with regard to overall survival, disease-free survival, distant metastases, and locoregional recurrence. However, well-performed studies of identical platinum-based combinations as neoadjuvant chemotherapeutic regimen are needed for further evaluation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Affiliated with the Eye and ENT Hospital of Fudan University, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Chen
authors.forename: Liang
authors.initials: L
authors.lastname: Zhou
authors.forename: Dongbin
authors.initials: D
authors.lastname: Chen
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Luo
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic
chemical_list: D016190:Carboplatin; D002945:Cisplatin