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
PMoLGGYM2021发布了新的文献求助10
1秒前
tzy完成签到,获得积分10
1秒前
2秒前
ZhaoRongzhe发布了新的文献求助10
2秒前
暴龙兽完成签到,获得积分20
3秒前
导师老八发布了新的文献求助10
3秒前
3秒前
4秒前
GG完成签到,获得积分10
4秒前
量子星尘发布了新的文献求助10
5秒前
ninomi完成签到,获得积分20
5秒前
诚心闭月发布了新的文献求助10
6秒前
6秒前
lzy完成签到,获得积分10
7秒前
顾矜应助稻草人采纳,获得30
7秒前
8秒前
9秒前
chw发布了新的文献求助10
9秒前
qsw发布了新的文献求助10
10秒前
风铃发布了新的文献求助10
12秒前
qpp完成签到,获得积分10
13秒前
小树发布了新的文献求助10
15秒前
妮妮完成签到,获得积分10
15秒前
搜集达人应助风铃采纳,获得10
17秒前
航某人完成签到,获得积分10
19秒前
科目三应助daisy采纳,获得30
19秒前
情怀应助ziming313采纳,获得10
19秒前
Tian完成签到,获得积分10
19秒前
Jasper应助白泽阳采纳,获得10
20秒前
qsw完成签到,获得积分10
20秒前
小机灵鬼完成签到,获得积分10
21秒前
几欢完成签到,获得积分10
23秒前
xl123发布了新的文献求助10
23秒前
小机灵鬼发布了新的文献求助10
24秒前
mariawang发布了新的文献求助10
25秒前
云魂完成签到,获得积分10
25秒前
杰ing完成签到,获得积分10
25秒前
打打应助魔幻的吐司采纳,获得10
26秒前
29秒前
29秒前
高分求助中
The Mother of All Tableaux Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 2400
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
Optimal Transport: A Comprehensive Introduction to Modeling, Analysis, Simulation, Applications 800
Official Methods of Analysis of AOAC INTERNATIONAL 600
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 3959677
求助须知:如何正确求助?哪些是违规求助? 3505910
关于积分的说明 11126825
捐赠科研通 3237865
什么是DOI,文献DOI怎么找? 1789389
邀请新用户注册赠送积分活动 871691
科研通“疑难数据库(出版商)”最低求助积分说明 802963