Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients.
Amand C, Armand JP, Bourhis J, Le Maître A, Luboinski B, Maillard E, Pignon JP, Lefebvre JL, Syz N, Bernier J, Budach V, Forastiere AA, Stewart AA, Vokes EE, Adelstein DJ, Armand JP, Amand C, Audry H, Bachaud JM, Bartelink HG, Bernier J, Bezwoda WR, Buffoli A, Bourhis J, Bhowmik KT, Brizel D, Browman GP, Budach V, Calais G, Campbell BH, Carugati A, Chalkidou S, Clark JR, Cohen E, Collette L, Dal Canton O, Dalley D, Depondt J, Désigné L, Deszcz-Thomas A, Di Blasio B, Dobrowsky W, Domenge C, Eschwege F, Evensen JF, Fallai C, Fischer JJ, Forastière AA, Fountzilas G, Fu KK, Gedouin D, Guérin S, Geara F, Giglio R, Gupta NK, Haddad E, Haffty BG, Hasegawa Y, Hill C, Horiot JC, Horiuchi M, Houghton J, Huguenin P, Jan P, Jaulerry Ch, Jeremic B, Jouffroy T, Jortay A, Kapstad B, Kowalski LP, Kramer S, Krishnamurthi KS, Kumar S, Laramore G, Lartigau E, Lefebvre JL, Le Maitre A, Leong T, Lewin F, Luboinski B, Luboinski M, Maillard E, Maipang T, Martin M, Mazeron JJ, Merlano M, Metha S, Molinari R, Monson K, Morita K, Mueller RP, Murias A, Mosseri V, Numico G, Olmi P, O'Sullivan B, Overgaard J, Paccagnella A, Pajak T, Parvinen LM, Pearlman NW, Pignon JP, Rao RS, Richard JM, Rufibach K, Sanchiz F, Sancho-Garnier H, Schuller DE, Shanta V, Simes RJ, Smid L, Stewart LA, Staar S, Strojan P, Stuetzer H, Szpirglas H, Schwaab G, Syz N, Takaku S, Taylor SG, Tobias JS, Toohill RJ, Vokes EE, Volling P, Weissler MC, Wendt T, Wernecke KD, Widder J, Wolf GT, Yoshino K.
Source
Department of Biostatistics and Epidemiology, Institut Gustave-Roussy, Villejuif, France. jppignon@igr.fr
Abstract
BACKGROUND:
Our previous individual patient data (IPD) meta-analysis showed that chemotherapy improved survival in patients curatively treated for non-metastatic head and neck squamous cell carcinoma (HNSCC), with a higher benefit with concomitant chemotherapy. However the heterogeneity of the results limited the conclusions and prompted us to confirm the results on a more complete database by adding the randomised trials conducted between 1994 and 2000.
METHODS:
The updated IPD meta-analysis included trials comparing loco-regional treatment to loco-regional treatment+chemotherapy in HNSCC patients and conducted between 1965 and 2000. The log-rank-test, stratified by trial, was used to compare treatments. The hazard ratios of death were calculated.
RESULTS:
Twenty-four new trials, most of them of concomitant chemotherapy, were included with a total of 87 trials and 16,485 patients. The hazard ratio of death was 0.88 (p<0.0001) with an absolute benefit for chemotherapy of 4.5% at 5 years, and a significant interaction (p<0.0001) between chemotherapy timing (adjuvant, induction or concomitant) and treatment. Both direct (6 trials) and indirect comparisons showed a more pronounced benefit of the concomitant chemotherapy as compared to induction chemotherapy. For the 50 concomitant trials, the hazard ratio was 0.81 (p<0.0001) and the absolute benefit 6.5% at 5 years. There was a decreasing effect of chemotherapy with age (p=0.003, test for trend).
CONCLUSION:
The benefit of concomitant chemotherapy was confirmed and was greater than the benefit of induction chemotherapy.
- PMID:
- 19446902
- [PubMed - indexed for MEDLINE]
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