Hinzunahme von Chemotherapie zur hyperfraktionierten Strahlentherapie bei fortgeschrittenen malignen Kopf- und Halstumoren – eine Metaanalyse

Translated title of the contribution: Addition of chemotherapy to hyperfractionated radiotherapy in advanced head and neck cancer—a meta-analysis

Jan Haussmann, Bálint Tamaskovics, Edwin Bölke, Freddy Joel Djiepmo-Njanang, Kai Kammers, Stefanie Corradini, Matthias Hautmann, Pirus Ghadjar, Kitti Maas, Patrick J. Schuler, Thomas K. Hoffmann, Guido Lammering, Wilfried Budach, Christiane Matuschek

Research output: Contribution to journalArticle

Abstract

Background: Adding concurrent chemotherapy (CTx) to definitive radiation therapy (RT) in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) improves overall survival. A comparable effect has been reported for hyperfractionated radiotherapy (HFX-RT) alone. Adding concurrent CTx to HFX-RT has been investigated in multiple trials, yet an evident effect on oncological outcomes and toxicity profile has not been established to date. Thus, the aim of the current study was to perform a meta-analysis on the clinical outcome and toxicity of the addition of CTx to HFX-RT. Patients and methods: We performed a literature search for randomized controlled trials comparing HFX-RT alone to HFX-RT + concurrent CTx in patients with LA-HNSCC undergoing definite RT. A meta-analysis was performed using the event rates and effect-sizes for overall survival (OS), progression-free survival (PFS), cancer-specific survival (CSS), distant metastasis-free survival and distant recurrence-free interval (DMFS/DMFI) and locoregional recurrence (LRR) as investigated endpoints. Furthermore, we compared selected acute and late toxicities in the included studies. Statistical analysis was performed using the Microsoft Excel (Microsoft, Redmont, WA, USA) add-in MetaXL 5.3 (EpiGear International, Sunrise Beach, Australia), utilizing the inverse variance heterogeneity model. Results: We identified six studies (n = 1280 patients) randomizing HFX-RT alone and the concurrent addition of CTx. OS was significantly improved in the HFX-RT + CTx group (HR = 0.77, CI95% = 0.66–0.89; p = <0.001). We found similar results in PFS (HR = 0.74, CI95% = 0.63–0.87; p < 0.001) and CSS (HR = 0.72, CI95% = 0.60–0.88; p = 0.001). In contrast, acute toxicities (≥grade 3 mucositis, ≥grade 3 dysphagia) and late adverse events including ≥grade 3 xerostomia, ≥grade 3 subcutaneous, ≥grade 3 bone, ≥grade 3 skin toxicity, and ≥grade 3 dysphagia did not significantly differ between the two groups. Conclusion: The addition of CTx to HFX-RT in the definitive treatment of advanced LA-HNSCC improves OS, CSS, PFS, and LRR without a significant increase in high-grade acute and late toxicities.

Translated title of the contributionAddition of chemotherapy to hyperfractionated radiotherapy in advanced head and neck cancer—a meta-analysis
Original languageGerman
Pages (from-to)1041-1049
Number of pages9
JournalStrahlentherapie und Onkologie
Volume195
Issue number12
DOIs
StatePublished - Dec 1 2019

Keywords

  • Acute and late side effects
  • Advanced head and neck cancer
  • Cancer-specific survival
  • Overall survival
  • Progression-free survival
  • Squamous cell carcinoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

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  • Cite this

    Haussmann, J., Tamaskovics, B., Bölke, E., Djiepmo-Njanang, F. J., Kammers, K., Corradini, S., Hautmann, M., Ghadjar, P., Maas, K., Schuler, P. J., Hoffmann, T. K., Lammering, G., Budach, W., & Matuschek, C. (2019). Hinzunahme von Chemotherapie zur hyperfraktionierten Strahlentherapie bei fortgeschrittenen malignen Kopf- und Halstumoren – eine Metaanalyse. Strahlentherapie und Onkologie, 195(12), 1041-1049. https://doi.org/10.1007/s00066-019-01511-z