Addition of chemotherapy to hyperfractionated radiotherapy in advanced head and neck cancer-a meta-analysis.
BACKGROUND
Adding concurrent chemotherapy (CTx) to definitive radiation therapy (RT) in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) improves overall survival. A comparable effect has been reported for hyperfractionated radiotherapy (HFX-RT) alone. Adding concurrent CTx to HFX-RT has been investigated in multiple trials, yet an evident effect on oncological outcomes and toxicity profile has not been established to date. Thus, the aim of the current study was to perform a meta-analysis on the clinical outcome and toxicity of the addition of CTx to HFX-RT.


PATIENTS AND METHODS
We performed a literature search for randomized controlled trials comparing HFX-RT alone to HFX-RT + concurrent CTx in patients with LA-HNSCC undergoing definite RT. A meta-analysis was performed using the event rates and effect-sizes for overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS), distant metastasis-free survival and distant recurrence-free interval (DMFS/DMFI) and locoregional recurrence (LRR) as investigated endpoints. Furthermore, we compared selected acute and late toxicities in the included studies. Statistical analysis was performed using the Microsoft Excel (Microsoft, Redmont, WA, USA) add-in MetaXL 5.3 (EpiGear International, Sunrise Beach, Australia), utilizing the inverse variance heterogeneity model.


RESULTS
We identified six studies (n = 1280 patients) randomizing HFX-RT alone and the concurrent addition of CTx. OS was significantly improved in the HFX-RT + CTx group (HR = 0.77, CI95% = 0.66-0.89; p = <0.001). We found similar results in PFS (HR = 0.74, CI95% = 0.63-0.87; p < 0.001) and CSS (HR = 0.72, CI95% = 0.60-0.88; p = 0.001). In contrast, acute toxicities (≥grade 3 mucositis, ≥grade 3 dysphagia) and late adverse events including ≥grade 3 xerostomia, ≥grade 3 subcutaneous, ≥grade 3 bone, ≥grade 3 skin toxicity, and ≥grade 3 dysphagia did not significantly differ between the two groups.


CONCLUSION
The addition of CTx to HFX-RT in the definitive treatment of advanced LA-HNSCC improves OS, CSS, PFS, and LRR without a significant increase in high-grade acute and late toxicities.
['Haussmann|Jan|J|', 'Tamaskovics|Bálint|B|', 'Bölke|Edwin|E|', 'Djiepmo-Njanang|Freddy-Joel|FJ|', 'Kammers|Kai|K|', 'Corradini|Stefanie|S|', 'Hautmann|Matthias|M|', 'Ghadjar|Pirus|P|', 'Maas|Kitti|K|', 'Schuler|Patrick J|PJ|', 'Hoffmann|Thomas K|TK|', 'Lammering|Guido|G|', 'Budach|Wilfried|W|', 'Matuschek|Christiane|C|']
D002294:Carcinoma, Squamous Cell D059248:Chemoradiotherapy D019583:Dose Fractionation, Radiation D005500:Follow-Up Studies D006801:Humans D009367:Neoplasm Staging D010039:Otorhinolaryngologic Neoplasms D000077982:Progression-Free Survival D016032:Randomized Controlled Trials as Topic
Squamous cell carcinoma Overall survival Progression-free survival Cancer-specific survival Acute and late side effects Advanced head and neck cancer