Zhang Lijuan, Jiang Nan, Shi Yuexian, Li Shipeng, Wang Peiguo, Zhao Yue
School of Nursing, Tianjin Medical University, Tianjin 300070, China.
First Central Clinical College of Tianjin Medical University, Tianjin 300192, China.
Sci Rep. 2015 Jun 4;5:10798. doi: 10.1038/srep10798.
Concurrent chemoradiotherapy (CCRT) has been considered to be the standard of care for locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). Whether induction chemotherapy (IC) with CCRT will further improve the clinical outcomes or not is still unclear. We conducted a meta-analysis to compare the two regimens for LA-SCCHN. Literature searches were carried out in PubMed, Embase, Cochrane Library and Chinese Biology Medicine from inception to November 2014. Five prospective randomized controlled trials (RCTs) with 922 patients were included in meta-analysis. Results were expressed as hazard ratios (HRs) or relative risks (RRs) with 95% confidence intervals (CIs). Compared with CCRT, IC with CCRT showed no statistically significant differences in overall survival (OS), progression-free survival (PFS), overall response rate (ORR) or locoregional recurrence rate (LRR), but could increase risks of grade 3-4 febrile neutropenia (P = 0.0009) and leukopenia (P = 0.04). In contrast, distant metastasis rate (DMR) decreased (P = 0.006) and complete response rate (CR) improved (P = 0.010) for IC with CCRT. In conclusion, the current studies do not support the use of IC with CCRT over CCRT, and the further positioning of IC with CCRT as standard treatment for LA-SCCHN will come from more RCTs directly comparing IC followed by CCRT with CCRT.
同步放化疗(CCRT)一直被视为局部晚期头颈部鳞状细胞癌(LA-SCCHN)的标准治疗方案。CCRT联合诱导化疗(IC)是否能进一步改善临床疗效仍不明确。我们进行了一项荟萃分析,以比较这两种治疗LA-SCCHN的方案。从创刊至2014年11月,在PubMed、Embase、Cochrane图书馆和中国生物医学数据库中进行了文献检索。五项前瞻性随机对照试验(RCT)共922例患者纳入荟萃分析。结果以风险比(HRs)或相对风险(RRs)及95%置信区间(CIs)表示。与CCRT相比,CCRT联合IC在总生存期(OS)、无进展生存期(PFS)、总缓解率(ORR)或局部区域复发率(LRR)方面无统计学显著差异,但会增加3-4级发热性中性粒细胞减少(P = 0.0009)和白细胞减少(P = 0.04)的风险。相比之下,CCRT联合IC的远处转移率(DMR)降低(P = 0.006),完全缓解率(CR)提高(P = 0.010)。总之,目前的研究不支持CCRT联合IC优于CCRT,CCRT联合IC作为LA-SCCHN标准治疗的进一步定位将来自更多直接比较IC序贯CCRT与CCRT的RCT。