Our previous meta-analysis showed that concomitant chemotherapy (CT) improved overall survival (OS) in patients with non-metastatic head and neck squamous cell carcinoma (HNSCC). The study purpose was to update patient follow up, gather data on toxicity and include randomized trials conducted up to 2010.
This individual patient data meta-analysis included trials comparing loco-regional treatment (LRT) to LRT + CT or induction CT + radiotherapy (RT) to RT + concomitant (or alternating) CT in non-metastatic HNSCC patients and conducted between 1965 and 2010. A fixed effect model was used. The log-rank test, stratified by trial, was used to compare treatments. OS was the primary endpoint.
15 new trials (2,574 patients) were included. Updated data were obtained for 11 additional trials. For the comparison of LRT vs. LRT + CT, 94 trials (18,394 patients) with median follow-up of 6.7 years were analyzed. The most frequent tumor site was oropharynx (35%). Stage III and IV tumors represented 29% and 63% of patients. The addition of CT improved OS with a hazard ratio (HR) [95% confidence interval] of 0.89 [0.86; 0.92], p
This update of the MACH-NC meta-analysis confirms the superiority of concomitant CT for locally advanced HNSCC with longer follow-up, when compared to induction treatment. Study of patterns of relapse and toxicity is ongoing.
Clinical trial identification
Legal entity responsible for the study
French Ministry of Health (Programme d'actions integrees de recherche VADS) Ligue Nationale Contre le Cancer French National Cancer Institute (SHS 2014-141) National Cancer Institute, National Institutes of Health (CA180888 and CA180819) Hellenic Cooperative Oncology Group (HE R_5G)
All authors have declared no conflicts of interest.