Comparison of Weekly and Triweekly Cisplatin Regimens in the Treatment of Head and Neck Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND

Cisplatin-based chemoradiotherapy is the standard treatment for locally advanced head and neck squamous-cell carcinoma (LA-HNSCC); however, the optimal dosing regimen remains debated. This systematic review and meta-analysis aimed to compare treatment compliance, therapeutic efficacy, and toxicity profiles between weekly (30-50 mg/m) and triweekly (100 mg/m every three weeks) cisplatin regimens in patients receiving concurrent radiotherapy for LA-HNSCC.

METHODS

A systematic literature search was conducted in PubMed, Google Scholar, and ClinicalTrials.gov to identify prospective clinical trials published before 16 January 2025, comparing weekly and triweekly cisplatin regimens. Studies were included if they reported treatment compliance, efficacy, and chemotherapy-related toxicities. Single-arm studies were excluded. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias (RoB) tool. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the primary endpoints: overall survival (OS) and chemotherapy completion rates. Heterogeneity was assessed using the I statistic.

RESULTS

Fifteen prospective clinical trials with 1572 patients (775 weekly and 797 triweekly) were included. Treatment compliance was similar between the regimens, with 74.76% (weekly) vs. 72.29% (triweekly) completing chemotherapy ( = 0.38). The mean cumulative cisplatin dose was significantly higher in the triweekly regimen (287.52 mg/m vs. 241.74 mg/m, = 0.04); however, the proportion of patients receiving a cumulative dose ≥200 mg/m did not differ significantly ( = 0.23). The therapeutic efficacy was comparable, with complete response rates of 63.18% (weekly) and 67.13% (triweekly) ( = 0.32) and OS rates at 2 years of 51.24% and 49.47% ( = 0.45). No significant differences were observed in the toxicity rates (any grade or grade ≥ 3) or mortality. The I statistic indicated insignificant heterogeneity across the studies.

INTERPRETATION

The results do not provide definitive evidence favoring one regimen over the other. Both regimens remain viable treatment options with comparable efficacy and adherence. Treatment selection should be individualized, considering toxicity risk, patient tolerability, and clinical factors.