Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis

医学 放射治疗 头颈部癌 头颈部 内科学 肿瘤科 荟萃分析 医学物理学 放射科 外科
作者
Claire Petit,Benjamin Lacas,Jean‐Pierre Pignon,Quynh‐Thu Le,Vincent Grégoire,Cai Grau,Allan Hackshaw,Björn Zackrisson,Mahesh Parmar,Ju-Whei Lee,Maria Grazia Ghi,Giuseppe Sanguineti,Stéphane Temam,M. Cheugoua-Zanetsie,Brian O’Sullivan,Marshall R. Posner,Everett E. Vokes,Juan Jesús Cruz,Z. Szutkowski,Éric Lartigau
出处
期刊:Lancet Oncology [Elsevier BV]
卷期号:22 (5): 727-736 被引量:78
标识
DOI:10.1016/s1470-2045(21)00076-0
摘要

Background Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. Methods We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). Findings 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0–9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97%; hazard ratio 0·63 [95% CI 0·51–0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRTP) was 0·82 (95% CI 0·66–1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRTP (P score 78%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (ICTaxPF-LRT; 89%), accelerated radiotherapy with concomitant chemotherapy (82%), and ICTaxPF followed by CLRT (80%). Interpretation The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or ICTaxPF-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. Fundings French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
爱因斯坦那个和我一样的科学家完成签到,获得积分10
5秒前
彭a完成签到,获得积分10
5秒前
Migrol完成签到,获得积分10
6秒前
高兴的小完成签到,获得积分10
6秒前
蕉鲁诺蕉巴纳完成签到,获得积分0
8秒前
慕青应助普鲁卡因采纳,获得10
8秒前
御剑乘风来完成签到,获得积分10
8秒前
李牛牛完成签到,获得积分10
12秒前
等待的代容完成签到,获得积分10
14秒前
传奇3应助小南孩采纳,获得10
14秒前
尊敬飞丹完成签到,获得积分10
15秒前
17秒前
离岸完成签到,获得积分10
17秒前
tian完成签到,获得积分10
19秒前
普鲁卡因发布了新的文献求助10
21秒前
daijk完成签到,获得积分10
22秒前
24秒前
风趣的烨磊完成签到,获得积分10
27秒前
仝富贵完成签到,获得积分10
28秒前
小南孩发布了新的文献求助10
29秒前
奔铂儿钯完成签到,获得积分10
30秒前
跳跃山柳完成签到,获得积分10
32秒前
量子星尘发布了新的文献求助10
34秒前
小南孩完成签到,获得积分10
37秒前
脑洞疼应助普鲁卡因采纳,获得10
43秒前
zhaoyaoshi完成签到 ,获得积分10
43秒前
chiazy完成签到,获得积分10
44秒前
智慧金刚完成签到 ,获得积分10
44秒前
汉堡包应助科研通管家采纳,获得10
44秒前
科研通AI2S应助科研通管家采纳,获得10
44秒前
44秒前
迪鸣完成签到,获得积分0
46秒前
浪费青春传奇完成签到 ,获得积分10
49秒前
少女徐必成完成签到 ,获得积分10
49秒前
健壮的思枫完成签到,获得积分10
50秒前
棱擎1号完成签到 ,获得积分10
51秒前
53秒前
tian发布了新的文献求助10
53秒前
panpanliumin完成签到,获得积分0
54秒前
普鲁卡因发布了新的文献求助10
56秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Handbook of Industrial Diamonds.Vol2 1100
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038112
求助须知:如何正确求助?哪些是违规求助? 3575788
关于积分的说明 11373801
捐赠科研通 3305604
什么是DOI,文献DOI怎么找? 1819255
邀请新用户注册赠送积分活动 892655
科研通“疑难数据库(出版商)”最低求助积分说明 815022