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:76
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
zhaoyaoshi发布了新的文献求助10
刚刚
刚刚
刚刚
量子星尘发布了新的文献求助30
1秒前
2秒前
3秒前
NexusExplorer应助博修采纳,获得10
4秒前
lwl666发布了新的文献求助10
4秒前
5秒前
7秒前
8秒前
wyh发布了新的文献求助10
8秒前
8秒前
怡然的无敌完成签到,获得积分10
9秒前
CY03完成签到,获得积分10
9秒前
10秒前
Atan完成签到,获得积分10
12秒前
鱼咬羊发布了新的文献求助10
12秒前
Henry完成签到,获得积分10
13秒前
14秒前
17秒前
17秒前
18秒前
盛芳完成签到 ,获得积分10
18秒前
研友_8yNxzL完成签到,获得积分10
18秒前
朝气完成签到,获得积分10
19秒前
jersey应助潇洒的白昼采纳,获得100
21秒前
博修发布了新的文献求助10
22秒前
22秒前
feng完成签到,获得积分10
23秒前
23秒前
Kia发布了新的文献求助10
23秒前
李健应助小曾采纳,获得10
23秒前
daifei完成签到,获得积分10
23秒前
24秒前
Bake完成签到 ,获得积分10
26秒前
26秒前
26秒前
28秒前
爆米花应助清蒸鱼采纳,获得30
28秒前
高分求助中
Ophthalmic Equipment Market by Devices(surgical: vitreorentinal,IOLs,OVDs,contact lens,RGP lens,backflush,diagnostic&monitoring:OCT,actorefractor,keratometer,tonometer,ophthalmoscpe,OVD), End User,Buying Criteria-Global Forecast to2029 2000
A new approach to the extrapolation of accelerated life test data 1000
Cognitive Neuroscience: The Biology of the Mind 1000
Cognitive Neuroscience: The Biology of the Mind (Sixth Edition) 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 588
Christian Women in Chinese Society: The Anglican Story 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
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 3961131
求助须知:如何正确求助?哪些是违规求助? 3507413
关于积分的说明 11135967
捐赠科研通 3239888
什么是DOI,文献DOI怎么找? 1790452
邀请新用户注册赠送积分活动 872420
科研通“疑难数据库(出版商)”最低求助积分说明 803152