title: Induction chemotherapy with concurrent chemoradiotherapy versus concurrent chemoradiotherapy for locally advanced squamous cell carcinoma of head and neck: a meta-analysis.
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.
authors.affiliation: School of Nursing, Tianjin Medical University, Tianjin 300070, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Zhang
authors.affiliation: School of Nursing, Tianjin Medical University, Tianjin 300070, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Jiang
authors.affiliation: School of Nursing, Tianjin Medical University, Tianjin 300070, China.
authors.forename: Yuexian
authors.initials: Y
authors.lastname: Shi
authors.affiliation: First Central Clinical College of Tianjin Medical University, Tianjin 300192, China.
authors.forename: Shipeng
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
authors.forename: Peiguo
authors.initials: P
authors.lastname: Wang
authors.affiliation: School of Nursing, Tianjin Medical University, Tianjin 300070, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects; D002986:Clinical Trials as Topic; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D017594:Publication Bias; D016896:Treatment Outcome