Wilfried Budach1, Edwin Bölke1, Kai Kammers2, Peter Arne Gerber3, Klaus Orth4, Stephan Gripp1, Christiane Matuschek5. 1. Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany. 2. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. 3. Medical Faculty, Department of Dermatology, Heinrich Heine University, Dusseldorf, Germany. 4. Medical Faculty, Department of General, Visceral, and Thoracic Surgery, Asklepios Harz Hospitals, Goslar, Germany. 5. Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany. Electronic address: matuschek@med.uni-duesseldorf.de.
Abstract
BACKGROUND: Induction chemotherapy with docetaxel, cisplatin and 5 FU (TPF) before radiotherapy (RT) or radio-chemotherapy (RT-CHX) has been shown to improve overall survival (OS) compared to induction chemotherapy with cisplatin and 5 FU in locally advanced squamous cell carcinoma of the head and neck (HNSCC). Whether TPF induction before RT-CHX improves clinical outcome in comparison with RT-CHX alone is still a matter of debate. Recently, the results of 5 randomized trials addressing this question have become available. METHODS: In the 5 trials of interest, in total 1022 patients with locally advanced HNSCC were randomly assigned to receive either TPF induction CHX followed by concurrent RT-CHX or concurrent RT-CHX alone. Platin or taxane based CHX was used during RT. 51.3% of the patients had oropharyngeal, 7.3% hypoharyngeal, 18.7% laryngeal, 19.4% oral cavity and 3.5% had other HNSCC. Published hazard ratios and hazard ratios extracted from available survival curves for OS and progression free survival (PFS) were basis of the meta-analysis. Meta-analysis of the effect sizes on OS and PFS was performed using a random effects model based on parameter estimates of log hazard ratios in Cox models and their standard errors. RESULTS: Additional induction CHX with TPF before RT-CHX did neither result in a significant improvement of OS (Hazard Ratio: 1.010, 95% confidence limits (CL) 0.84-1.21, p=0.92), nor in a statistically significant benefit of PFS (Hazard Ratio: 0.91, 95% CL 0.75-1.1, p=0.32). CONCLUSION: Additional induction CHX with TPF before RT-CHX does not improve OS and PFS in locally advanced HNSCC compared to definite RT-CHX.
BACKGROUND: Induction chemotherapy with docetaxel, cisplatin and 5 FU (TPF) before radiotherapy (RT) or radio-chemotherapy (RT-CHX) has been shown to improve overall survival (OS) compared to induction chemotherapy with cisplatin and 5 FU in locally advanced squamous cell carcinoma of the head and neck (HNSCC). Whether TPF induction before RT-CHX improves clinical outcome in comparison with RT-CHX alone is still a matter of debate. Recently, the results of 5 randomized trials addressing this question have become available. METHODS: In the 5 trials of interest, in total 1022 patients with locally advanced HNSCC were randomly assigned to receive either TPF induction CHX followed by concurrent RT-CHX or concurrent RT-CHX alone. Platin or taxane based CHX was used during RT. 51.3% of the patients had oropharyngeal, 7.3% hypoharyngeal, 18.7% laryngeal, 19.4% oral cavity and 3.5% had other HNSCC. Published hazard ratios and hazard ratios extracted from available survival curves for OS and progression free survival (PFS) were basis of the meta-analysis. Meta-analysis of the effect sizes on OS and PFS was performed using a random effects model based on parameter estimates of log hazard ratios in Cox models and their standard errors. RESULTS: Additional induction CHX with TPF before RT-CHX did neither result in a significant improvement of OS (Hazard Ratio: 1.010, 95% confidence limits (CL) 0.84-1.21, p=0.92), nor in a statistically significant benefit of PFS (Hazard Ratio: 0.91, 95% CL 0.75-1.1, p=0.32). CONCLUSION: Additional induction CHX with TPF before RT-CHX does not improve OS and PFS in locally advanced HNSCC compared to definite RT-CHX.
Authors: Natalie M Lowe; Jonathan M Bernstein; Kathleen Mais; Kate Garcez; Lip W Lee; Andrew Sykes; David J Thomson; Jarrod J Homer; Catharine M West; Nicholas J Slevin Journal: J Cancer Res Clin Oncol Date: 2017-12-08 Impact factor: 4.553
Authors: M Hecht; S Semrau; M Beck; J Hartwich; M Eckstein; D Schmidt; A O Gostian; S Müller; S Rutzner; U S Gaipl; J von der Grün; T Illmer; M G Hautmann; G Klautke; J Döscher; T Brunner; B Tamaskovics; A Hartmann; H Iro; T Kuwert; R Fietkau Journal: Ann Nucl Med Date: 2022-05-10 Impact factor: 2.258