Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 93 randomised trials and 17,346 patients

Abstract Background Our previous individual patient data (IPD) meta-analysis showed that chemotherapy improved survival in patients curatively treated for non-metastatic head and neck squamous cell carcinoma (HNSCC), with a higher benefit with concomitant chemotherapy. However the heterogeneity of t...

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Bibliographic Details
Published in:Radiotherapy and oncology 2009-07, Vol.92 (1), p.4-14
Main Authors: Pignon, Jean-Pierre, Maître, Aurélie le, Maillard, Emilie, Bourhis, Jean
Format: Article
Language:English
Subjects:
Antineoplastic Agents - therapeutic use
Carcinoma, Squamous Cell - drug therapy
Carcinoma, Squamous Cell - radiotherapy
Chemotherapy
Combined Modality Therapy
Head and neck cancer
Head and Neck Neoplasms - drug therapy
Head and Neck Neoplasms - radiotherapy
Hematology, Oncology and Palliative Medicine
Humans
Individual patient data
Meta-analysis
Meta-Analysis as Topic
Radiotherapy
Randomised clinical trials
Randomized Controlled Trials as Topic
Systematic review
Treatment Outcome
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Summary:Abstract Background Our previous individual patient data (IPD) meta-analysis showed that chemotherapy improved survival in patients curatively treated for non-metastatic head and neck squamous cell carcinoma (HNSCC), with a higher benefit with concomitant chemotherapy. However the heterogeneity of the results limited the conclusions and prompted us to confirm the results on a more complete database by adding the randomised trials conducted between 1994 and 2000. Methods The updated IPD meta-analysis included trials comparing loco-regional treatment to loco-regional treatment + chemotherapy in HNSCC patients and conducted between 1965 and 2000. The log-rank-test, stratified by trial, was used to compare treatments. The hazard ratios of death were calculated. Results Twenty-four new trials, most of them of concomitant chemotherapy, were included with a total of 87 trials and 16,485 patients. The hazard ratio of death was 0.88 ( p < 0.0001) with an absolute benefit for chemotherapy of 4.5% at 5 years, and a significant interaction ( p < 0.0001) between chemotherapy timing (adjuvant, induction or concomitant) and treatment. Both direct (6 trials) and indirect comparisons showed a more pronounced benefit of the concomitant chemotherapy as compared to induction chemotherapy. For the 50 concomitant trials, the hazard ratio was 0.81 ( p < 0.0001) and the absolute benefit 6.5% at 5 years. There was a decreasing effect of chemotherapy with age ( p = 0.003, test for trend). Conclusion The benefit of concomitant chemotherapy was confirmed and was greater than the benefit of induction chemotherapy.
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2009.04.014