Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and randomized trials.

Author:

El-Sayed S,Nelson N

Abstract

PURPOSE Using the technique of meta-analysis, we aim to illustrate the potential benefit, or lack of it, in adding chemotherapy to locoregional definitive treatment in a prospective randomized setting. PATIENTS AND METHODS Mantel-Haenszel summary analyses were used to test 42 prospective and properly randomized trials for statistically significant differences in the proportion with side effects and in the proportion with response to treatment between the experimental treatment arm (including chemotherapy) and control arm (local definitive treatment only) of the study. Summarized estimates of relative risks of side effects and relative proportions of positive responses were obtained using the summarizing options in PROC FREQ in the SAS computer package. In 25 of 42 studies, sufficient survival information was available to estimate the effect of chemotherapy on the rate of dying per person per unit of time. RESULTS Chemotherapy, when added to local definitive treatment, was found to increase toxicity. This increase is statistically significant. The relative proportion of side effects was 2.17, with a 95% confidence interval of 1.84 to 2.56 and P less than .001. Addition of chemotherapy to local treatment has reduced the mortality rate for treated patients by 11% in the total group (all 25 studies), with a 95% confidence interval of 1% to 19%. This reduction means that at the time 50% of patients in the control arm were still alive, 54% of patients who received chemotherapy would be expected to be alive. Concurrent treatment (11 studies) has reduced the mortality rate by 22%, with a 95% confidence interval of 8% to 33%, which means that at the time 50% of patients in the control arm were still alive, 58% of patients who received chemotherapy would be expected to be alive. CONCLUSION Addition of chemotherapy to local definitive treatment has significantly increased the morbidity of treatment as well as the chance of initial tumor response and local control. A statistically significant improvement in survival was found for the simultaneous use of chemotherapy and local definitive treatment.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3