A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC)

Abstract

PurposeThis study was performed to compare the efficacies and acute toxicities in weekly- and three weekly- cisplatin based concurrent chemoradiotherapy (CCRT) for advanced HNC patients.Results779 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.MethodsWe 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.ConclusionsThree 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.

Comparing high‐dose cisplatin with cisplatin‐based combination chemotherapy in definitive concurrent chemoradiation setting for locally advanced head and neck squamous cell carcinoma (LAHNSCC)

“…Only randomized study comparing low (30 m/m 2 ) versus high dose (100 mg/m 2 ) cisplatin prospectively found inferior locoregional disease control with low dose cisplatin. While other studies revealed inferior overall survival with low‐dose cisplatin compare to high‐dose cisplatin . Despite the controversy of high and low dose cisplatin, 15% of LAHNSCC patients in the United States receive weekly low‐dose cisplatin with radiation according to LORHAN analysis.…”

WP1130 attenuates cisplatin resistance by decreasing P53 expression in non-small cell lung carcinomas

“…Cisplatin was used for metastatic cutaneous squamous cell carcinoma and yielded an overall response rate of 45% and prolonged disease-free survival [ 8 ]. Cisplatin was also suitable for treating non-nasopharyngeal carcinoma, and every three weekly chemotherapy strategy yielded better 5-year overall survival outcomes as compared to a weekly chemotherapy strategy [ 9 ]. Cisplatin is used for most patients with NSCLCs and forms the basis of first-line chemotherapy [ 10 ].…”

Optimal Administration Frequency of Cisplatin Concurrently With Radical Radiotherapy in the Definitive Treatment of Locally Advanced, Inoperable Squamous Cell Cancer of the Head and Neck. Still Obscured by Clouds?

“…There are currently four meta-analyses/systematic reviews (Table 1) that should have provided a detailed, both quantitative and qualitative, synthesis of the existing data. [4][5][6][7] The data from the most recent study by Sturz et al from 2019 [8] are the same as ones published originally in 2017. [5] Different time periods focused upon in these meta-analyses naturally resulted in a different number and type of studies included (main and separate analysis), and consequentially a different patient number, unfortunately not always specified.…”

“…In spite of these shortcomings, it is remarkable to observe that there is no significant difference in not only OS, but LRFS, PFS, and RR as well. Regarding toxicity, while Guan et al [4] and Mohamed et al [7] found no difference in any of documented toxicities, Jacinto et al [6] found Grade >3 mucositis significantly more frequent in weekly CDDP, but only in a single RCT (using postoperative RT-CHT), while there was no difference in six retrospective studies using concurrent RT-CHT alone. In Sturz et al [5], the administration of CDDP every 3 weeks led to significantly more leucopenia, neutropenia, N&V and nephrotoxicity, with no difference in incidence rates of stomatitis and mucositis.…”

“…In Sturz et al [5], the administration of CDDP every 3 weeks led to significantly more leucopenia, neutropenia, N&V and nephrotoxicity, with no difference in incidence rates of stomatitis and mucositis. The only study that found the 3-weekly regimen less toxic was that of Guan et al [4], but only when high-grade mucositis in non-NPC treated with RT-CHT alone was considered sepa- 1. Elderly and/or frail patients, alcohol and/or tobacco consumers, and those with impaired kidney function will likely be advised for weekly CDDP administration.…”