title: Concomitant chemoradiotherapy versus altered fractionation radiotherapy in the radiotherapeutic management of locoregionally advanced head and neck squamous cell carcinoma: An adjusted indirect comparison meta-analysis.
abstract: BACKGROUND
  Treatment intensification by using chemoradiotherapy (CRT) or altered fractionation radiotherapy (RT) improves outcomes in locoregionally advanced head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Two comprehensive meta-analyses with similar control arms (conventionally fractionated RT) were compared indirectly.
  
  
  RESULTS
  The hazard ratio (HR) of death with 95% confidence interval (CI) for the overall comparison of altered fractionation RT with concomitant CRT was 1.13 (95% CI, 0.97-1.29; p = .07) suggesting no significant difference between both approaches. Compared to concomitant CRT, the HR for death was 1.01 (95% CI, 0.89-1.15; p = .82); 1.22 (95% CI, 0.94-1.59; p = .13); and 1.22 (95% CI, 1.07-1.39; p = .002) for hyperfractionated RT; accelerated RT without total dose reduction; and accelerated RT with total dose reduction, respectively.
  
  
  CONCLUSIONS
  Concomitant CRT and hyperfractionated RT are comparable to one another on indirect comparison in the radiotherapeutic management of locoregionally advanced HNSCC. Any form of acceleration (with or without total dose reduction) may not compensate fully for lack of chemotherapy.
authors.affiliation: Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Hospital Centre, Kharghar, Navi Mumbai, India; Epidemiology and Clinical Trials Unit, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Hospital Centre, Kharghar, Navi Mumbai, India.
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.forename: Sadhana
authors.initials: S
authors.lastname: Kannan
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh-Laskar
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Agarwal
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: altered fractionation; concomitant chemoradiotherapy; hyperfractionation; indirect comparison; meta-analysis