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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 and 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, vol.~76, JAN 2018, p.~52-60. ISSN~1368-8375. Available from: https://dx.doi.org/10.1016/j.oraloncology.2017.11.025.
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