Mixed treatment comparison meta-analysis of altered fractionated radiotherapy and chemotherapy in head and neck cancer

Blanchard, Pierre; Hill, Catherine; Guihenneuc‐Jouyaux, Chantal; Baey, Charlotte; Bourhis, Jean; Pignon, Jean-Pierre

doi:10.1016/j.jclinepi.2010.10.016

Cited by 61 publications

(43 citation statements)

References 31 publications

(47 reference statements)

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“…The present evidence for altered fractionation CCRT is based on a network or mixed treatment comparison meta-analysis combining direct and indirect comparisons from MACH-NC and MARCH dataset allowing simultaneous inference from pairwise comparisons of all possible modes of combining chemotherapy with radiotherapy or altering fractionation. In this pooled analysis [42] of over 24 000 patients in 102 comparisons, altered fractionation CCRT was associated with the highest survival in non-metastatic HNSCC (hazard ratio ¼ 0.70, 95% confidence interval ¼ 0.61e0.80) followed by conventionally fractionated CCRT (hazard ratio ¼ 0.82, 95% confidence interval ¼ 0.78e0.86).…”

Section: Discussionmentioning

confidence: 94%

Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

et al. 2016

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Section: Discussionmentioning

confidence: 94%

Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

et al. 2016

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“…3). [152][153][154] It may occur in approximately 5% of patients. ORN most commonly affects the mandible and is staged according to the treatment indicated 155 or by lesion size and symptoms (Table 10).…”

Section: 145mentioning

confidence: 99%

Oral complications of cancer and cancer therapy

Epstein

Thariat

Bensadoun

et al. 2012

CA A Cancer J Clinicians

411

356

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Answer questions and earn CME/CNEOral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long‐term oral health and general well‐being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long‐term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long‐term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. CA Cancer J Clin 2012. © 2012 American Cancer Society.

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“…2 In the Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC), the addition of induction chemotherapy using cisplatin plus fluorouracil (PF) to local treatment did not decrease locoregional failures. 3 Hence PF induction chemotherapy is not considered as a standard treatment in locoregionally advanced HNSCC, except in the case of larynx preservation, for which both PF induction chemotherapy and concomitant CRT are considered standard. 2 An exploratory indirect analysis of survival in the MACH-NC database has shown that CRT was superior to PF induction chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Taxane-Cisplatin-Fluorouracil As Induction Chemotherapy in Locally Advanced Head and Neck Cancers: An Individual Patient Data Meta-Analysis of the Meta-Analysis of Chemotherapy in Head and Neck Cancer Group

Blanchard

Bourhis

Lacas

et al. 2013

JCO

Self Cite

260

160

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PURPOSE Cisplatin plus fluorouracil (PF) induction chemotherapy has been compared with taxane (docetaxel or paclitaxel), cisplatin, and fluorouracil (Tax-PF) in randomized trials in locoregionally advanced head and neck cancers (LAHNCs). The aim of this meta-analysis was to study the efficacy and toxicity of Tax-PF and PF and identify differences in outcomes in subsets of patients. METHODS Five randomized trials representing 1,772 patients were identified. Updated individual patient data (IPD) were retrieved for all trials. The log-rank test, stratified by trial, was used for comparison. Interaction or trend tests were used to study the interaction between covariates and treatment. Results Median follow-up was 4.9 years. The hazard ratio (HR) of death was 0.79 (95% CI, 0.70 to 0.89; P < .001; absolute benefit at 5 years: 7.4%) in favor of Tax-PF. Heterogeneity was significant (P = .08, I(2) = 51%) and related to one trial. There was no more heterogeneity after exclusion of this trial (P = .99, I(2) = 0%), and HR of death was 0.72 (95% CI, 0.63 to 0.83) in favor of Tax-PF. There was no interaction between treatment effect and the following patient covariates: age, sex, performance status, tumor stage, or site. Tax-PF was associated with significant reductions of progression, locoregional failure, and distant failure compared with PF, with HRs of 0.78 (95% CI, 0.69 to 0.87; P < .001), 0.79 (95% CI, 0.66 to 0.94; P = .007), and 0.63 (95% CI, 0.45 to 0.89; P = .009) respectively. CONCLUSION This IPD meta-analysis shows the superiority of Tax-PF over PF as induction chemotherapy. Its precise role in the management of LAHNC remains to be determined.

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Mixed treatment comparison meta-analysis of altered fractionated radiotherapy and chemotherapy in head and neck cancer

Cited by 61 publications

References 31 publications

Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

Oral complications of cancer and cancer therapy

Taxane-Cisplatin-Fluorouracil As Induction Chemotherapy in Locally Advanced Head and Neck Cancers: An Individual Patient Data Meta-Analysis of the Meta-Analysis of Chemotherapy in Head and Neck Cancer Group

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