Clinical efficacy of neoadjuvant chemotherapy with platinum-based regimen for patients with locoregionally advanced head and neck squamous cell carcinoma: an evidence-based meta-analysis

• Published in: Annals of Saudi medicine Vol. 31; no. 5; pp. 502 - 512
• Main Authors: Chen, Hui, Zhou, Liang, Chen, Dongbin, Luo, Jianfeng
• Format: Journal Article
• Language: English
• Published: Saudi Arabia Medknow Publications and Media Pvt. Ltd 01.09.2011; KING FAISAL SPECIALIST HOSPITAL & RESEARCH CENTRE; Medknow Publications
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bias; Cancer; Cancer therapies; Carboplatin - administration & dosage; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Care and treatment; Chemotherapy; Cisplatin - administration & dosage; Clinical trials; Diagnosis; Disease control; Disease-Free Survival; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Health aspects; Humans; Larynx; Meta-analysis; Neoadjuvant Therapy - methods; Neoplasm Recurrence, Local; Neoplasm Staging; Original; Platinum; Radiation therapy; Randomized Controlled Trials as Topic; Sensitivity analysis; Squamous cell carcinoma; Saudi Arabia
• ISSN: 0256-4947; 0975-4466
• DOI: 10.4103/0256-4947.84629

As a vital chemotherapeutic modality, the clinical benefits of neoadjuvant chemotherapy still remain uncertain and controversial. The purpose of this meta-analysis was to evaluate the efficacy of neoadjuvant chemotherapy with a platinum-based regimen for patients with locoregional stage III or IV squamous cell carcinoma of the head and neck. Meta-analysis of randomized, controlled trials. Relevant randomized controlled trials (RCTs) were identified through systematic search and selected according to the inclusion and exclusion criteria. Eligible RCTs were further analyzed by systematic meta-analysis. Statistical analysis was performed by Review Manager 5.0.21.0 software. A total of 6 RCTs were identified. Pooling effects revealed that there was no statistical significance in locoregional recurrence [relative risk (RR)= 1.06; 95% CI (confidence interval= 0.91-1.24; P>.05], distant metastasis (RR= 0.6; 95% CI= 0.28-1.30; P>.05), disease-free survival (RR= 0.93; 95% CI= 0.75-1.15; P>.05) or overall survival (RR= 0.98; 95% CI= 0.89-1.09; P>.05). More of the common hematological adverse effects were reported with a cisplatin-based regimen. All the studies analyzed in this meta-analysis were individual RCTs with adequate follow-up and relatively narrow confidence intervals, which were classified to the 1b level, and this meta-analysis was classified to the 1a level, according to the Levels of Evidence (March 2009) of Oxford Center for Evidence-based Medicine. The meta-analysis indicates there is a non-significant difference between neoadjuvant chemotherapeutic treatment and conventional locoregional modality for patients at high risk of recurrence, with regard to overall survival, disease-free survival, distant metastases, and locoregional recurrence. However, well-performed studies of identical platinum-based combinations as neoadjuvant chemotherapeutic regimen are needed for further evaluation.