Clinical efficacy of neoadjuvant chemotherapy with platinum-based regimen for patients with locoregionally advanced head and neck squamous cell carcinoma: an evidence-based meta-analysis

Abstract

BACKGROUND AND OBJECTIVES:As a vital chemotherapeutic modality, the clinical benefits of neoadjuvant chemotherapy still remain uncertain and controversial. The purpose of this meta-analysis was to evaluate the efficacy of neoadjuvant chemotherapy with a platinum-based regimen for patients with locoregional stage III or IV squamous cell carcinoma of the head and neck.DESIGN AND SETTING:Meta-analysis of randomized, controlled trials.METHODS:Relevant randomized controlled trials (RCTs) were identified through systematic search and selected according to the inclusion and exclusion criteria. Eligible RCTs were further analyzed by systematic meta-analysis. Statistical analysis was performed by Review Manager 5.0.21.0 software.RESULTS:A total of 6 RCTs were identified. Pooling effects revealed that there was no statistical significance in locoregional recurrence [relative risk (RR)= 1.06; 95% CI (confidence interval= 0.91-1.24; P>.05], distant metastasis (RR= 0.6; 95% CI= 0.28-1.30; P>.05), disease-free survival (RR= 0.93; 95% CI= 0.75-1.15; P>.05) or overall survival (RR= 0.98; 95% CI= 0.89-1.09; P>.05). More of the common hematological adverse effects were reported with a cisplatin-based regimen. All the studies analyzed in this meta-analysis were individual RCTs with adequate follow-up and relatively narrow confidence intervals, which were classified to the 1b level, and this meta-analysis was classified to the 1a level, according to the Levels of Evidence (March 2009) of Oxford Center for Evidence-based Medicine.CONCLUSIONS:The meta-analysis indicates there is a non-significant difference between neoadjuvant chemotherapeutic treatment and conventional locoregional modality for patients at high risk of recurrence, with regard to overall survival, disease-free survival, distant metastases, and locoregional recurrence. However, well-performed studies of identical platinum-based combinations as neoadjuvant chemotherapeutic regimen are needed for further evaluation.

Systemic therapy in the curative treatment of head and neck squamous cell cancer: A systematic review

“…Out of these 214 reports, 21 reviews were considered potentially eligible and full text reports of 21 reviews were retrieved and reviewed. Ten reviews with pooled analysis [2, 3, 9–16] were identified as potentially relevant to the topic areas covered by this guideline. Three reports focused on induction chemotherapy, two on postoperative chemotherapy, two on targeted agents, one on concurrent chemotherapy and in two reports, the timing of chemotherapy not specified.…”

“…After full text review, five meta-analyses [2–4, 14–16] were included. Four [9–11, 13] were excluded because they reviewed RCTs of non-LASCCHN, and one meta-analysis [12] was excluded following AMSTAR assessment. No further discussions of these references will be made in this guideline.…”

“…As randomized Phase II trials have not demonstrated a benefit of taxane-cisplatin doublets compared with PF [9, 17] we limited the scope of eligible RCTs to those adding paclitaxel or docetaxel to PF. Nine eligible RCTs were identified.…”

Efficacy evaluation of different measurement methods for target lesions after neoadjuvant chemotherapy and radical radiotherapy in locally advanced hypopharyngeal carcinoma

“…2,3 Neoadjuvant chemotherapy (NACT) has a significant role in the comprehensive treatment of hypopharyngeal carcinoma (HPC). 4 The response evaluation criteria for solid tumors (RECIST) 1.1 are commonly used to assess tumor response to the treatment for HPC by evaluating tumor load changes based on a dimensional measurement. 5 However, due to the complexity of the anatomic location and mucosal spread of HPC, where the tumor often has complex shapes and irregular margins, the long dimension cannot always be accurately measured by evaluators.…”

A novel extracellular drug conjugate significantly inhibits head and neck squamous cell carcinoma

“…Survival of head and neck cancer patients has slightly improved following the use local therapies, such as surgery or radiotherapy, in large part due to locoregional and distant metastatic failure [10]. While, systemic monotherapy using platinum based compounds have limited response rates except when combined with radiotherapy [11–14]. Whereas, targeted systemic therapy with monoclonal antibodies lacks the potency necessary to completely halt tumorigenesis resulting in varied response rates and limited improvement in survival rates [15].…”