Induction chemotherapy in patients with resectable head and neck squamous cell carcinoma: a meta-analysis
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Induction chemotherapy in patients with resectable head and neck squamous cell carcinoma: a meta-analysis Jie Ma†, Ying Liu†, Xi Yang, Chen-ping Zhang, Zhi-yuan Zhang and Lai-ping Zhong*
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. Keywords: Induction chemotherapy, Resectable head and neck squamous cell carcinoma, Randomized controlled trial, Meta-analysis
Background Head and neck squamous cell carcinoma (HNSCC) ranks sixth among the most common cancers worldwide with an incidence of over 500,000 new cases each year [1]. Patients at an early stage clinical (stages I and II), are typically treated with single modality therapy, usually surgery or radiation therapy, with excellent disease control and long-term survival. For patients with more advanced disease, at clinical stages III and IV, comprehensive, sequential treatment regimens consisting of surgery, and/or * Correspondence: [email protected] † Equal contributors Department of Oral Maxillofacial-Head Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, No.639 Zhizaoju Rd, Shanghai, 200011, China
radiotherapy, with or without chemotherapy are mostly required [2]. However, the prognosis has not been significantly improved; the 5-year survival rate remains about
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