Adjuvant chemotherapy in head and neck cancer

Stell, P. M.

doi:10.1016/1053-4296(92)90008-9

Cited by 41 publications

(12 citation statements)

References 49 publications

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“…The data on local control are consistent This overview of trials of adjuvant chemotherapy in head and neck cancer suggests that chemotherapy might improve survival and that this improvement is more apparent for single-agent chemotherapy given synchronously with radiotherapy. Since two previous meta-analyses (Stell and Rawson, 1990;Stell, 1992) failed to show benefit from chemotherapy, the discrepancies between these previous analyses and the current results must be explained. Stell and Rawson's first analysis (1990) included 23 trials, and the updated analysis added five newer trials to give a total of 28 trials (Stell, 1992 Cumulative meta-analyses, and the current study could be regarded as the third in a sequence for head and neck cancer, can be useful for the prompt detection of therapeutic advances.…”

Section: Reksmentioning

confidence: 53%

“…Since two previous meta-analyses (Stell and Rawson, 1990;Stell, 1992) failed to show benefit from chemotherapy, the discrepancies between these previous analyses and the current results must be explained. Stell and Rawson's first analysis (1990) included 23 trials, and the updated analysis added five newer trials to give a total of 28 trials (Stell, 1992 Cumulative meta-analyses, and the current study could be regarded as the third in a sequence for head and neck cancer, can be useful for the prompt detection of therapeutic advances. Experience from trials of treatment for myocardial infarction showed that, although early overviews were negative, the accumulation of evidence eventually favoured active therapy (Antman et al., 1992; Lau et al, 1992).…”

Section: Reksmentioning

confidence: 53%

“…The values were obtained by applying a set square to the survival curve at the specified time point, reading off the percentage surviving, and thereby calculating, from the total number randomised to that group, the absolute number of survivors. The validity of the abstracted data was assessed by repeated cross-checking and also, where possible, by comparison with the data presented in previous overviews (Stell and Rawson, 1990;Stell, 1992). Of necessity, however, the data used are crude and, at best, approximate.…”

Section: Methodsmentioning

confidence: 99%

“…Response rates to chemotherapy are high, but this responsiveness does not appear to translate into durable benefit in terms of survival. Recent metaanalyses of adjuvant chemotherapy for squamous cell carcinoma of the head and neck failed to show any benefit from such treatment (Stell and Rawson, 1990;Stell, 1992). However, several randomised trials published subsequently have been reported as showing benefit from adding chemotherapy to standard therapy.…”

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An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

1995

Br J Cancer

315

120

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Summary Meta-analysis of the published results from 54 randomised controlled trials of adjuvant chemotherapy in head and neck cancer suggests that chemotherapy might increase absolute survival by 6.5% (95% confidence interval 3.1-9.9%). The odds ratio in favour of chemotherapy is 1.37 (95% confidence interval 1.24-1.5). Single-agent chemotherapy given synchronously with radiotherapy increased survival by 12.1% (95% confidence interval 5-19%). The benefit from neoadjuvant chemotherapy was less: a rate difference of 3.7% (95% confidence interval 0.9-6.5%). The results suggest that the investigation of optimal agents and scheduling for synchronous radiotherapy and chemotherapy might still be important in clinical trials in head and neck cancer.Keywords: overview; randomised trials; head and neck cancer Attitudes towards cytotoxic chemotherapy for squamous carcinomas of the head and neck range from enthusiasm (Dimery and Hong, 1993) to disdain (Tannock and Browman, 1986;Taylor, 1987). Response rates to chemotherapy are high, but this responsiveness does not appear to translate into durable benefit in terms of survival. Recent metaanalyses of adjuvant chemotherapy for squamous cell carcinoma of the head and neck failed to show any benefit from such treatment (Stell and Rawson, 1990;Stell, 1992). However, several randomised trials published subsequently have been reported as showing benefit from adding chemotherapy to standard therapy. In order better to define the possible role for chemotherapy and to suggest possibly fruitful avenues for exploration, a further meta-analysis of published randomised clinical studies of adjuvant chemotherapy in head and neck cancer has been performed.The primary purpose of this overview was to discover whether the addition of chemotherapy to definitive standard therapy improved survival in patients with cancer of the head and neck. Secondary objectives included an assessment of whether the timing of chemotherapy, before, during or after standard therapy, was important; a specific assessment of the effectiveness of platinum/5-fluorouracil (5-FU) regimens; an evaluation of single-agent chemotherapy given synchronously with radiotherapy; an assessment of the effect of chemotherapy upon locoregional control rates; an assessment of the effect of chemotherapy upon the occurrence of distant metastases. Materials and methodsA structured search was conducted to identify randomised clinical trials of chemotherapy in head and neck cancer. A trial was suitable for inclusion if it fulfilled the following criteria. *

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Section: Reksmentioning

confidence: 53%

Section: Reksmentioning

confidence: 53%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

1995

Br J Cancer

315

120

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Meta-analysis of chemotherapy in head and neck cancer: individual patient data vs literature data

Pignon¹,

Bourhis²

1995

Br J Cancer

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Sir - Munro (1995) should be thanked for updating the meta-analysis on the role of chemotherapy in head and neck cancer performed by Stell (1992) and for his well-conducted sensitivity analysis. In his meta-analysis, based on the literature, he identified 54 eligible trials published between January 1963 and December 1993. In the ongoing metaanalysis of chemotherapy in head and neck cancer (MACH-NC), based on updated individual patient data, we have identified 70 eligible trials (list available on request) with accrual between January 1965 and December 1993. The comparison of both studies provides us with an opportunity to discuss the advantages of the two types of meta-analyses.Munro identified 45 out of 70 trials in MACH-NC. However, nine additional trials that were eligible in his study were excluded from MACH-NC: one trial on nasopharynx carcinoma; one trial on maxillary sinus carcinoma; three old trials, for which accrual started before 1965; one trial comparing chemotherapy with radiotherapy; and three trials, each generating two separate publications, one of them concerning a subgroup analysis, were considered by Munro as separate trials whereas in fact they concerned one and the same trial. Our study retained only the publication with the largest population. The analysis performed by Munro has the following shortcomings. The main analysis included only 48 of 54 trials (7443 patients) because survival rates were not available in the publication of six trials. It mixed up survival rates ranging from 2 to 5 years according to the trials. The analysis included the results of two trials twice, once for the overall populations and once for the subgroups (Munro's references 25 and 26) as noted above, and also included two trials on organ preservation. The aim of such trials is to avoid mutilating surgery when chemotherapy is used without compromising survival and not to test whether chemotherapy increases survival.Therefore, 25 trials were identified in the MACH-NC study and not in Munro's study, including 11 trials published as full papers before 1994; nine trials published as abstracts including eight abstracts of the American Society of Clinical Oncology, -four of which were published in 1994; and five unpublished trials. With the help of investigators joining the MACH-NC Collaborative Group, we hope not only to update the follow-up and recover the data concerning the patients excluded after the randomisation of the 70 identified trials, which have included 10422 patients, but also to discover new trials. Then it will be possible to perform a survival analysis (log-rank test adjusted by trial) of all patients ever randomised (intent-to-treat analysis). We are currently exploring the feasibility of including old trials (before 1965) and nasopharynx trials. In MACH-NC, the four identified organ preservation trials, like the nasopharynx trials, will be analysed separately. This meta-analysis will also allow us to study disease-free survival and interactions between prognostic factors and the treatment effect. T...

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Radiotherapy for squamous cell carcinoma of the supraglottic larynx: An alternative to surgery

et al. 1996

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Adjuvant chemotherapy in head and neck cancer

Cited by 41 publications

References 49 publications

An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

An overview of randomised controlled trials of adjuvant chemotherapy in head and neck cancer

Meta-analysis of chemotherapy in head and neck cancer: individual patient data vs literature data

Radiotherapy for squamous cell carcinoma of the supraglottic larynx: An alternative to surgery

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