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Meta-Analysis
. 2013 Mar 14:11:67.
doi: 10.1186/1477-7819-11-67.

Induction chemotherapy in patients with resectable head and neck squamous cell carcinoma: a meta-analysis

Jie Ma  1 , Ying Liu, Xi Yang, Chen-ping Zhang, Zhi-yuan Zhang, Lai-ping Zhong
Affiliations
Meta-Analysis

Induction chemotherapy in patients with resectable head and neck squamous cell carcinoma: a meta-analysis

Jie Ma et al. World J Surg Oncol. .

Abstract

Background: Induction chemotherapy has been investigated as a possible strategy to shrink or downstage locally advanced head and neck cancers, providing opportunity to remove the lesions completely after induction chemotherapy, especially in the patients with resectable advanced disease. The aim of this study was to investigate the definitive effect of induction chemotherapy in patients with resectable head and neck squamous cell carcinoma.

Methods: A meta-analysis of randomized trials (1965-2011) was performed on the impact of induction chemotherapy on survival, disease control, and toxicity in this population of patients. Kaplan-Meier curves were read by Engauge-Digitizer. Data combining was performed using RevMan.

Results: Fourteen trials (2099 patients) were involved in this analysis. There was no significant difference on overall survival, disease free survival, or locoregional recurrence between the patients treated with and without induction chemotherapy (P >0.05). However, the patients treated with induction chemotherapy had a lower rate of distant metastasis by 8% (95% confidence interval 1%-16%, P = 0.02) than those treated without induction chemotherapy. In patients with laryngeal cancer, comparing to radical surgery, the larynx could be preserved in responders to induction chemotherapy without survival decease (P >0.05). Induction chemotherapy-associated death was 0%-5%.

Conclusions: Based on the results above, there is a significant benefit of induction chemotherapy on decreasing distant metastasis in patients with resectable head and neck squamous cell carcinoma. In patients with laryngeal cancer, induction chemotherapy provides larynx preservation in responders to induction chemotherapy.

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Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Forest plot of hazard ratios for overall survival and 95% CI in fourteen randomized controlled trials in patients with resectable head and neck squamous cell carcinoma treated with induction chemotherapy followed by locoregional treatment, or locoregional treatment alone. Richard 1991a23 is for cancer of the floor of the mouth, Richard 1991b23 is for cancer of the posterior oral cavity and oropharynx. Volling 199413, Richard 199827, Lewin 199714, Paccagnella 200411, Domenge 200015, Licitra 200316, Lefebvre 199624, Veterans Affairs 199827, Kohno 200021, Maipang 199519, Schuller 198820, Jortay 199022.
Figure 3
Figure 3
Forest plot of hazard ratios for disease-free survival and 95% CI in patients with resectable head and neck squamous cell carcinoma treated with induction chemotherapy followed by locoregional treatment, or locoregional treatment alone. Richard 1991a23 is for cancer of the floor of the mouth, Richard 1991b23 is for cancer of the posterior oral cavity and oropharynx. Jacobs 198717, Lefebvre 199624, Paccagnella 200411, Richard 199825, Veterans Affairs 199827, Volling 199413.
Figure 4
Figure 4
Forest plot of hazard ratios of distant metastasis-free survival and 95% CI in patients with resectable head and neck squamous cell carcinoma treated with induction chemotherapy followed by locoregional treatment, or locoregional treatment alone. Richard 1991a23 is for cancer of the floor of the mouth, Richard 1991b23 is for cancer of the posterior oral cavity and oropharynx. Hasegawa 199618, Licitra 200316, Paccagnella 200411.
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