Abstract
Background
Our previous individual patient data (IPD) meta-analysis showed that chemotherapy
improved survival in patients curatively treated for non-metastatic head and neck
squamous cell carcinoma (HNSCC), with a higher benefit with concomitant chemotherapy.
However the heterogeneity of the results limited the conclusions and prompted us to
confirm the results on a more complete database by adding the randomised trials conducted
between 1994 and 2000.
Methods
The updated IPD meta-analysis included trials comparing loco-regional treatment to
loco-regional treatment + chemotherapy in HNSCC patients and conducted between 1965 and 2000. The log-rank-test,
stratified by trial, was used to compare treatments. The hazard ratios of death were
calculated.
Results
Twenty-four new trials, most of them of concomitant chemotherapy, were included with
a total of 87 trials and 16,485 patients. The hazard ratio of death was 0.88 (p < 0.0001) with an absolute benefit for chemotherapy of 4.5% at 5 years, and a significant interaction (p < 0.0001) between chemotherapy timing (adjuvant, induction or concomitant) and treatment.
Both direct (6 trials) and indirect comparisons showed a more pronounced benefit of
the concomitant chemotherapy as compared to induction chemotherapy. For the 50 concomitant
trials, the hazard ratio was 0.81 (p < 0.0001) and the absolute benefit 6.5% at 5 years. There was a decreasing effect of chemotherapy with age (p = 0.003, test for trend).
Conclusion
The benefit of concomitant chemotherapy was confirmed and was greater than the benefit
of induction chemotherapy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Radiotherapy and OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Ferlay F, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: cancer incidence, mortality and prevalence worldwide. IARC Cancer Base No. 5. Version 2.0. Lyon: IARC Press; 2004.
- Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data.Lancet. 2000; 255: 949-955
- A graphical method for exploring heterogeneity in meta-analysis: application to a meta-analysis of 65 trials.Stat Med. 2002; 21: 2641-2652
- Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): an update.Int J Radiat Oncol Biol Phys. 2007; 69: S112-S114
- A note on quantifying follow-up in studies of failure time.Control Clin Trials. 1996; 17: 343-346
- Beta blockade during and after myocardial infarction: an overview of randomised clinical trials.Prog Cardiovasc Dis. 1985; 27: 335-371
- Effects of radiotherapy and surgery in early breast cancer: an overview of randomized trials.N Engl J Med. 1995; 333: 1444-1455
- Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials.Br Med J. 1995; 311: 899-909
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Systemic treatment of early breast cancer by hormonal, cytotoxic or immune therapy: 133 randomised trials involving 31,000 recurrences and 24,000 death among 75,000 women.Lancet. 1992; 339: 1-15
- A cooperative AIRO/Piemonte randomized clinical trial of carboplatin as an adjunct to radiotherapy in head and neck cancer.Radiat Oncol. 1994; 32: S93
- Concomitant chemoradiotherapy in advanced head and neck cancers: Safdarjang hospital experience.Radiat Oncol. 2001; 58: S16
- Radiation alone versus radiation with weekly low dose cisplatinum in unrescetable cancer of the head and neck.in: Head and neck cancer. vol. II. BC Decker, Philadelphia1990: 279-281
- Hyperfractionated or accelerated radiotherapy in head and neck cancer: an individual patient data meta-analysis of 15 randomized trials.Lancet. 2006; 368: 843-854
Available from: http://www.emea.europa.eu/humandocs/PDFs/EPAR/erbitux/Erbitux-H-558-II-05.pdf [last access on November 26, 2008].
- Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer.J Clin Oncol. 2005; 23: 8636-8645
- Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer.N Engl J Med. 2007; 357: 1705-1715
- Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer.N Engl J Med. 2007; 357: 1695-1704
- Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck.N Engl J Med. 2006; 354: 567-578
Article info
Publication history
Published online: May 18, 2009
Accepted:
April 19,
2009
Received in revised form:
April 17,
2009
Received:
April 6,
2009
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
