Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Mar 29;19(1):282.
doi: 10.1186/s12885-019-5412-z.

Comparative efficacy of six therapies for Hypopharyngeal and laryngeal neoplasms: a network meta-analysis

Juan Che  1 , Yanlin Wang  1 , Xiaolin Zhang  1 , Jun Chen  2
Affiliations
Comparative Study

Comparative efficacy of six therapies for Hypopharyngeal and laryngeal neoplasms: a network meta-analysis

Juan Che et al. BMC Cancer. .

Abstract

Background: Hypopharyngeal and laryngeal neoplasms are both fatal and hard to catch in early stages. Yet which treatment is the most efficacious one still remain unanswered. This network meta-analysis (NMA) was conducted to investigate effectiveness of six therapies being utilized in clinical practice nowadays.

Methods: PubMed and Embase were retrieved to synthesize data. Direct and indirect evidence was combined to compare efficacy of treatments. A relative ranking of the six regimens was calculated by the surface under the curve ranking area (SUCRA).

Results: A total of 28 trials with 9109 patients were included in our NMA. Five endpoints investigated included 3/5-year overall survival (3/5-OS), 3/5-year disease free survival (3/5-DFS) and 5-year overall survival rate (5-OSR). In terms of all efficacy outcomes, radiotherapy combined with surgery (RT + S) proved to be better than other therapies while radiotherapy (RT) alone also performed well. Induction chemoradiotherapy (ICRT) was the best regarding 3-DFS (SUCRA = 0.846) while current chemoradiotherapy (CCRT) ranked first in 5-DFS (SUCRA = 0.933) according to SUCRA results. No significant differences were demonstrated in 5-DFS and 5-OSR as shown in the results of NMA.

Conclusions: RT combined with surgery turned out to be optimal therapy of all the outcomes while the efficacy of RT was relatively poorer in the treatment of patients with larynx stage III-IV and hypopharynx stage II-IV. Also, the good performance of CCRT and ICRT in terms of DFS made them as secondary recommended therapies. There is no significant difference between surgery and transoral laser microsurgery (TLM) alone.

Keywords: Efficacy; Hypopharyngeal neoplasm; Laryngeal neoplasm; Network meta-analysis.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The network of comparisons of 3-OS, 5-OS, 3-DFS, and 5-DFS. (The width of the lines is proportional to the number of trials comparing each pair of treatments; the area of circles represents the cumulative number of patients for each intervention.) S, surgery; RT, radiotherapy; TLM, transoral laser microsurgery; RT + S, surgery combined with radiotherapy; ICRT, Induction chemotherapy radiotherapy; CCRT, current chemotherapy radiotherapy
Fig. 2
Fig. 2
Forest plots for four endpoints. Hazard ratio (HRs) and 95% credible interval (CrIs) indicate the relative efficacy under the corresponding endpoint. S, surgery; RT, radiotherapy; TLM, transoral laser microsurgery; RT + S, surgery combined with radiotherapy; ICRT, Induction chemotherapy radiotherapy; CCRT, current chemotherapy radiotherapy
Fig. 3
Fig. 3
The results of consistency analysis by heat plot for each outcome. The size of the gray squares indicates the contribution of the direct evidence (shown in the column) to the network evidence (shown in the row). The colors are associated with the change in inconsistency between direct and indirect evidence (shown in the row) and the warmer color represents the stronger inconsistency. S, surgery; RT, radiotherapy; TLM, transoral laser microsurgery; RT + S, surgery combined with radiotherapy; ICRT, Induction chemotherapy radiotherapy; CCRT, current chemotherapy radiotherapy
See this image and copyright information in PMC

References

    1. Marur S, Forastiere AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2016;91(3):386–396. doi: 10.1016/j.mayocp.2015.12.017. - DOI - PubMed
    1. Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, Morrison W, Glisson B, Trotti A, Ridge JA, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31(7):845–852. doi: 10.1200/JCO.2012.43.6097. - DOI - PMC - PubMed
    1. Wolf GT, Fisher SG, Hong WK, Hillman R, Spaulding M, Laramore GE, Endicott JW, McClatchey K, Henderson WG. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324(24):1685–1690. doi: 10.1056/NEJM199106133242402. - DOI - PubMed
    1. Ghadjar P, Simcock M, Zimmermann F, Betz M, Bodis S, Bernier J, Studer G, Aebersold DM, Swiss Group for Clinical Cancer R Predictors of severe late radiotherapy-related toxicity after hyperfractionated radiotherapy with or without concomitant cisplatin in locally advanced head and neck cancer. Secondary retrospective analysis of a randomized phase III trial (SAKK 10/94) Radiother Oncol. 2012;104(2):213–218. doi: 10.1016/j.radonc.2012.05.004. - DOI - PubMed
    1. Huang G, Luo M, Zhang J, Liu H. Laser surgery versus radiotherapy for T1a glottic carcinoma: a meta-analysis of oncologic outcomes. Acta Otolaryngol. 2017;137(11):1204–1209. doi: 10.1080/00016489.2017.1353706. - DOI - PubMed

Publication types

LinkOut - more resources