Concomitant platinum-based chemotherapy or cetuximab with radiotherapy for locally advanced head and neck cancer: A systematic review and meta-analysis of published studies

The combinations of radiotherapy (RT) plus chemotherapy (CTRT) with cisplatin or, alternatively, RT plus cetuximab (RT + CET), are the treatments of choice for locally advanced squamous cell carcinoma of the head and neck (HNSCC). We performed a systematic review and meta-analysis of published studies reporting the efficacy of these 2 combined modality therapies for the treatment of locoregionally advanced HNSCC. We performed a systematic search of PUBMED, EMBASE, Web of Science, SCOPUS, and the Cochrane Register of Controlled Trials. Meta-analysis was performed using the fixed- or random- effects models. The primary endpoints were 2-year overall survival (OS), 2-year progression-free survival (PFS), and 2-year locoregional relapse (LRR), reported as risk ratios (RRs) and 95% confidence intervals (CIs). Fifteen trials, including a total of 1808 patients, were analysed. Three of these trials were prospective, and 12 were retrospective. Overall, for locally advanced HNSCC, concomitant CTRT significantly improved 2-year OS (RR = 0.66; 95% CI, 0.46-0.94; P = 0.02), 2-year PFS (RR = 0.68; 95% CI, 0.53-0.87; P = 0.002), and 2-year LRR (RR = 0.63; 95% CI, 0.45-0.87; P = 0.005) compared to RT + CET. For the treatment of locally advanced HNSCC, platinum-based CTRT is associated with a better OS and PFS compared to RT + CET, and this is probably attributed to improved locoregional disease control. Thus, platinum-based CTRT should remain the standard of care until equivalence with RT + CET can be prospectively demonstrated. (C) 2014 Elsevier Ltd. All rights reserved.