A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC).
OBJECTIVE
This study was performed to compare the efficacies and acute toxicities in weekly- and three weekly- cisplatin based concurrent chemoradiotherapy (CCRT) for advanced HNC patients.


RESULTS
779 patients of 10 studies were eligible. No difference in the 2-, 3-year OS or 1-, 2-year LRFS was observed, whereas patients in three weekly CCRT arm tended to have a better 5-year OS (HR=1.79, 95%C 0.97-3.31, p=0.06). Weekly arm seemed to show less gastrointestinal toxicities (RR=0.59, 95%CI 0.34-1.02, p=0.06), but similar hematologic toxicity compared to three weekly arm. Subgroup analysis displayed more grade ≥3 mucositis (RR=1.72, p=0.01), and more chemotherapy related delay/interrupt (RR=2.68, p<0.0001) in weekly arm for non-nasopharynx carcinoma (non-NPC) HNC.


METHODS
We conducted the meta-analysis by searching PubMed, MEDLINE, ScienceDirect, Cochrane Library and China National Knowledge Infrastructure (CNKI) databases. The primary endpoint was overall survival (OS) with secondary endpoints locoregional recurrence-free survival (LRFS) and grade≥3 acute adverse events. RevMan 5.2 was used to perform statistical analyses.


CONCLUSIONS
Three weekly cisplatin-based CCRT might achieve a higher long-term OS with no significant difference in a shorter OS and LRFS. Weekly arm was associated with less gastrointestinal toxicities but more grade≥3 mucositis and chemotherapy related delay/interrupt. Large randomized trials were urgent to further define superiority of these two regimens.
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Jian
J
Guan
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Yue
Y
Zhang
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Qinyang
Q
Li
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Yaowei
Y
Zhang
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Lu
L
Li
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Min
M
Chen
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Nanjie
N
Xiao
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Longhua
L
Chen
D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged
D002945:Cisplatin
cancer; cisplatin; head and neck; meta-analysis; therapy