Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): A comprehensive analysis by tumour site

Blanchard, Pierre; Baujat, B.; Holostenco, V.; Bourredjem, Abderrahmane; Baey, Charlotte; Bourhis, Jean; Pignon, Jean-Pierre

doi:10.1016/j.radonc.2011.05.036

Cited by 549 publications

(385 citation statements)

References 19 publications

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“…These perfusion models are useful in eliminating complicating or confounding factors, such as variability in fl ap geometry and co-morbid disease, which are inherent in clinical cases. In addition, this study design permitted standardized treatment doses and recovery times following neoadjuvant therapy, which often vary widely in clinical studies [14].…”

Section: Discussionmentioning

confidence: 99%

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

Ramesh¹,

Moore²,

Patel³

et al. 2017

Arch Otolaryngol Rhinold

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IntoductionThe clinical management of locally advanced cancers of the head and neck pose a signifi cant therapeutic challenge [1]. Despite advances in the fi eld, including the routine use of microvascular free tissue transfers in the reconstruction of defects, fl ap failure persists as a troublesome complication 2 . The underlying factors that infl uence the development of fl ap failure are varied and complex, including comorbid systemic diseases, positive surgical margins, lymph node metastases, and prior radiotherapy and/or chemotherapy [1][2][3].Radiation and chemotherapy are often administered neoadjuvantly, or prior to surgical intervention, to gauge Abstract Purpose: Minimizing surgical morbidity after local fl ap reconstruction is important in the management of cutaneous defects. Controversy exists in current literature regarding the effects of radiation and chemotherapy on fl ap perfusion. Neoadjuvant treatments can damage the microvasculature of the surgical bed through fi brosis, endothelial cell damage, and reduced cell proliferation, which collectively increase the likelihood of postoperative fl ap failure. The aim of this study is to examine the effects of neoadjuvant radiation and chemotherapy on skin fl ap perfusion.Methods: Animals were divided into three groups: control (no treatment, n=4), radiation group (36-Gy administered to dorsal skin, n=4), and chemotherapy group (2 mg/kg IP cisplatin, n=4). Treatments were performed 15 days prior to random-pattern dorsal fl ap surgery, with a fl ap length-to-width ratio of 4:1 (4x1cm2). Flap perfusion was assessed via laser-assisted (Luna, Novadaq) indocyanine green dye angiography and standard clinical assessment. Results:Fluorescence imaging was used to quantify fl ap perfusion as a fraction of healthy skin perfusion. Chemotherapy group fl aps had poorer distal end perfusion than radiation or control group fl aps (56% vs. 69% and 71%, respectively) on post-operative day (POD) 1. Clinical assessment of fl ap perfusion by experienced surgeons on POD2 found chemotherapy group fl aps to be least viable. By POD5, 100% of chemotherapy group fl aps had experienced complete fl ap loss as measured by clinical evaluation and perfusion imaging. Conclusion:Flaps receiving neoadjuvant chemotherapy performed worse than those receiving local radiotherapy or no treatment. We demonstrate the detrimental effect of neoadjuvant chemotherapy on fl ap viability in this preclinical murine model.

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Section: Discussionmentioning

confidence: 99%

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

Ramesh¹,

Moore²,

Patel³

et al. 2017

Arch Otolaryngol Rhinold

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“…Although concurrent chemoradiotherapy has been demonstrated as an effective treatment for locally advanced head and neck cancer, its efficacy for early-stage hypopharyngeal cancer is not clear. A meta-analysis showed no benefit of chemotherapy in addition to radiotherapy in stage I-II hypopharyngeal cancer (hazard ratio=1.01) (14). Thus, further prospective study is warranted to establish the optimal combination of chemotherapy and radiotherapy for early-stage hypopharyngeal cancer.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Definitive and Postoperative Radiotherapy for Stage I-IVB Hypopharyngeal Cancer

Shirai

Saitoh

Abe

et al. 2016

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“…The benefit of concomitant chemo-radiotherapy (CRT) has been widely investigated (Pignon et al, 2009;Blanchard et al, 2011). The majority of studies and meta-analyses found that CRT significantly improves both local control (LC) and overall survival (OS).…”

Section: Introductionmentioning

confidence: 99%

“…We focused on 5-year efficacy outcomes because at this time a clinical benefit in terms of OS has been reported by previous meta-analyses (Pignon et al, 2009;Blanchard et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and mucosal toxicity of concomitant chemo-radiotherapy in patients with locally-advanced squamous cell carcinoma of the head-and-neck in the light of a novel mathematical model

Strigari

Pinnarò²,

Carlini³

et al. 2016

Critical Reviews in Oncology/Hematology

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Background: In the last several decades, combined radiotherapy (RT) and chemotherapy (CT) have beenrecognized as feasible in locally-advanced-squamous-cell-carcinoma of the head-and-neck (LA-HNSCC).Several meta-analyses identified concurrent RT + CT (CRT) most likely effective approach respect toRT-alone. However, radiobiological models comparing different chemotherapeutic schedules againstdelivered RT fractionation schedule for overall survival and toxicity are still needed.Methods and materials: Based on 9 randomized trials (2785 patients), radiobiological models andmultivariate logistic regression model were used to derive dose-response curves and estimate the 5-year-overall survival (OS) and ≥G3 acute mucositis rate of CRT or RT-alone.Results: Equivalent dose at 2 Gy/fraction (EQD2) was calculated using the linear quadratic model. Theeffect of CRT schedules, considering the CT type and its administration schedule and the HPV status oftumors were estimated using the univariate/multivariate logistic regression. The multivariate logisticregression model for 5y-OS indicated EQD2 and the type of CT, the chemo-sensitization fraction and theHPV status significant prognostic factors, while for toxicity both EQD2 and the concomitant adminis-tration of 5-fluorouracil (5Fu) resulted as significant prognostic factors. Combined schedules cisplatin(DDP)+/−5Fu + RT produced the higher OS compared with combined carboplatin+/−5Fu + RT or RT-alone

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Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): A comprehensive analysis by tumour site

Cited by 549 publications

References 19 publications

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

Effects of Neoadjuvant Chemotherapy and Radiotherapy on Flap Perfusion in a Novel Mouse Model Using Standard Clinical Assessment and Near-Infrared Fluorescence Angiography

Clinical Outcomes of Definitive and Postoperative Radiotherapy for Stage I-IVB Hypopharyngeal Cancer

Efficacy and mucosal toxicity of concomitant chemo-radiotherapy in patients with locally-advanced squamous cell carcinoma of the head-and-neck in the light of a novel mathematical model

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