title: Survival, recurrence and toxicity of HNSCC in comparison of a radiotherapy combination with cisplatin versus cetuximab: a meta-analysis.
abstract: Cisplatin-based treatment has been considered the standard treatment regimen of HNSCC. Cetuximab is an emerging target therapy that has potential therapeutic benefits over cisplatin. Nevertheless, curative effects of cisplatin-based chemoradiotherapy (CRT) versus cetuximab-based bioradiotherapy (BRT) are still controversial.
  
  
  
  Potentially eligible studies were retrieved using PubMed, Embase and Medline. Basic characteristics of patients and statistical data were collected. A meta-analysis model was established to compare CRT and BRT.
  
  
  
  Thirty-one eligible studies and 4212 patients were found. The pooled HRs with 95 % confidence intervals (CIs) for OS and PFS were 0.32 [0.09, 0.55] and 0.51 [0.22, 0.80], respectively, and both were in favor of cisplatin. However, 3-year survival and recurrence analysis of the subgroups showed no differences between the two groups (p > 0.05). In subgroup analysis, oropharyngeal primary tumors exhibited improved results by cetuximab with a pooled HR of 1.56 [1.14, 2.13] for PFS. Additionally, the HPV+ status was a significant factor in positive outcomes with cetuximab with a pooled HR of 1.12 [0.46, 2.17] for OS.
  
  
  
  Long-term use of BRT showed no significant difference compared with CRT, and both arms showed different aspects of toxicity. In subgroup analysis, taking the effects of treatment and adverse events into consideration, cetuximab plus radiation may show superior responses regarding OS and PFS in patients who have HPV+ or primary oropharyngeal HNSCC, respectively, but physicians should administer them with caution.
authors: Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
authors: Jingwen
authors: J
authors: Huang
authors: West China Medical School, West China Hospital, Sichuan University, Chengdu, China.
authors: Jing
authors: J
authors: Zhang
authors: West China Medical School, West China Hospital, Sichuan University, Chengdu, China.
authors: Changle
authors: C
authors: Shi
authors: State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School Sichuan University, Chengdu, China. liuleihx@gmail.com.
authors: Lei
authors: L
authors: Liu
authors: State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School Sichuan University, Chengdu, China.
authors: Yuquan
authors: Y
authors: Wei
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D000068818:Cetuximab / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods*; D002945:Cisplatin / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D000077195:Squamous Cell Carcinoma of Head and Neck
chemical_list: D000970:Antineoplastic Agents; D000068818:Cetuximab; D002945:Cisplatin
keywords: Adverse event; Cetuximab; Cisplatin; HNSCC; HPV; Oropharynx; Prognosis; Radiotherapy; Recurrence