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@article{1446336, author = {Szturz, Petr and Wouters, Kristien and Kiyota, Naomi and Tahara, Makoto and Prabhash, Kumar and Noronha, Vanita and Adelstein, David and Vermorken, Jan B.}, article_location = {AMSTERDAM}, article_number = {JAN 2018}, doi = {http://dx.doi.org/10.1016/j.oraloncology.2017.11.025}, keywords = {Head and neck cancer; Concurrent chemoradiotherapy; Meta-analysis; Radiotherapy dose fractionation; Cisplatin; Survival}, language = {eng}, issn = {1368-8375}, journal = {Oral oncology}, title = {Altered fractionation radiotherapy combined with concurrent low-dose or high-dose cisplatin in head and neck cancer: A systematic review of literature and meta-analysis}, volume = {76}, year = {2018} }
TY - JOUR ID - 1446336 AU - Szturz, Petr - Wouters, Kristien - Kiyota, Naomi - Tahara, Makoto - Prabhash, Kumar - Noronha, Vanita - Adelstein, David - Vermorken, Jan B. PY - 2018 TI - Altered fractionation radiotherapy combined with concurrent low-dose or high-dose cisplatin in head and neck cancer: A systematic review of literature and meta-analysis JF - Oral oncology VL - 76 IS - JAN 2018 SP - 52-60 EP - 52-60 PB - ELSEVIER SCIENCE BV SN - 13688375 KW - Head and neck cancer KW - Concurrent chemoradiotherapy KW - Meta-analysis KW - Radiotherapy dose fractionation KW - Cisplatin KW - Survival N2 - Objectives: Altered fractionation radiotherapy and concomitant chemoradiotherapy represent commonly used intensification strategies in the management of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). This meta-analysis compares compliance, safety, and efficacy between two single-agent cisplatin schedules given concurrently with altered fractionation radiotherapy. Methods: We systematically searched for prospective trials of patients with LA-SCCHN who received post-operative or definitive altered fractionation concurrent chemoradiotherapy. High-dose cisplatin once every three to four weeks (100 mg/m(2), 2 doses) was compared with a weekly low-dose protocol (<= 50 mg/m2, >= 4 doses). The primary outcome was overall survival. The secondary endpoints comprised treatment adherence, acute and late toxicities, and objective response rate. Results: Twelve studies with 1373 patients treated with definitive chemoradiotherapy were included. Compared to the weekly low-dose cisplatin regimen, the three-to four-weekly high-dose cisplatin regimen improved overall survival (p = .0185), was more compliant with respect to receiving all planned cycles of cisplatin (71% versus 95%, p = .0353), and demonstrated less complications in terms of severe (grade 3-4) acute mucositis and/or stomatitis (75% versus 40%, p =. 0202) and constipation (8% versus 1%, p = .0066), toxic deaths (4%, versus 1%, p = .0168), 30-day mortality (8% versus 3%, p = .0154), and severe late subcutaneous fibrosis (21% versus 2%, p < .0001). Overall and complete response rates were similar between both chemotherapy schedules. Conclusion: In chemoradiotherapy incorporating altered fractionation, two cycles of high-dose cisplatin with a three to four week interval are superior to weekly low-dose schedules. Further studies should identify those who might derive the greatest benefit from this intensified approach. ER -
SZTURZ, Petr, Kristien WOUTERS, Naomi KIYOTA, Makoto TAHARA, Kumar PRABHASH, Vanita NORONHA, David ADELSTEIN a Jan B. VERMORKEN. Altered fractionation radiotherapy combined with concurrent low-dose or high-dose cisplatin in head and neck cancer: A systematic review of literature and meta-analysis. \textit{Oral oncology}. AMSTERDAM: ELSEVIER SCIENCE BV, 2018, roč.~76, JAN 2018, s.~52-60. ISSN~1368-8375. Dostupné z: https://dx.doi.org/10.1016/j.oraloncology.2017.11.025.
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