Information de reference pour ce titreAccession Number: | 00005531-200003180-00008.
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Author: | Pignon, J P; Bourhis, J; Domenge, C; Designe, L; on behalf of the MACH-NC Collaborative Group *
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Institution: | Institut Gustav-Roussy, Villejuif, France (J P Pignon MD, J Bourhis MD, C Domenge MD, L Designe BSc)
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Title: | Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data.[Article]
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Source: | Lancet. 355(9208):949-955, March 18, 2000.
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Abstract: | Background: Despite more than 70 randomised trials, the effect of chemotherapy on non-metastatic head and neck squamous-cell carcinoma remains uncertain. We did three meta-analyses of the impact of survival on chemotherapy added to locoregional treatment.
Methods: We updated data on all patients in randomised trials between 1965 and 1993. We included patients with carcinoma of the oropharynx, oral cavity, larynx, or hypopharynx.
Findings: The main meta-analysis of 63 trials (10 741 patients) of locoregional treatment with or without chemotherapy yielded a pooled hazard ratio of death of 0.90 (95% CI 0.85-0.94, p<0.0001), corresponding to an absolute survival benefit of 4% at 2 and 5 years in favour of chemotherapy. There was no significant benefit associated with adjuvant or neoadjuvant chemotherapy. Chemotherapy given concomitantly to radiotherapy gave significant benefits, but heterogeneity of the results prohibits firm conclusions. Meta-analysis of six trials (861 patients) comparing neoadjuvant chemotherapy plus radiotherapy with concomitant or alternating radiochemotherapy yielded a hazard ratio of 0.91 (0.79-1.06) in favour of concomitant or alternating radiochemotherapy. Three larynx-preservation trials (602 patients) compared radical surgery plus radiotherapy with neoadjuvant chemotherapy plus radiotherapy in responders or radical surgery and radiotherapy in non-responders. The hazard ratio of death in the chemotherapy arm as compared with the control arm was 1.19 (0.97-1.46).
Interpretation: Because the main meta-analysis showed only a small significant survival benefit in favour of chemotherapy, the routine use of chemotherapy is debatable. For larynx preservation, the non-significant negative effect of chemotherapy in the organ-preservation strategy indicates that this procedure must remain investigational.
Copyright. (C) The Lancet Ltd, 2000.
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References: | 1 Parkin DM, Muir CS, Whelan SL, Gao YT, Ferlay J, Powell J. Cancer incidence in five continents. Vol 6. Lyon: IARC, 1992.
2 Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics, 1996. CA Cancer J Clin 1996; 65: 5-27.
3 Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med 1993; 328: 184-94.
4 Hahari P. Why has induction chemotherapy for advanced head and neck cancer become a United States community standard of practice? J Clin Oncol 1997; 15: 2050-55.
5 Schemper M, Smith TL. A note on quantifying follow-up in studies of failure time. Controlled Clin Trials 1996; 17: 343-46.
6 Yusuf S, Peto R, Lewis J, Collins R, Sleight T. Beta blockade during and after myocardial infarction: an overview of randomised clinical trials. Prog Cardiovasc Dis 1985; 27: 335-71.
7 Stewart LA, Parmar MKB. Meta-analysis of the literature or individual patient data: is there a difference? Lancet 1993; 341: 418-22.
8 The Department of Veteran Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991; 324: 1685-90.
9 Richard JM, Sancho-Garnier H, Pessey JJ, et al. Randomized trial of induction chemotherapy in larynx carcinoma. Eur J Cancer 1998; 34: 224-28.
10 Lefebvre JL, Chevalier D, Luboinski B, et al. Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. J Natl Cancer Inst 1996; 88: 890-99.
11 Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials. BMJ 1995; 311: 899-909.
12 Bourhis J, Pignon JP. Meta-analyses in head and neck squamous cell carcinoma: what is the role of chemotherapy? Hematol Oncol Clin North Am 1999; 13: 769-75.
13 Oxman AD, Clarke MJ, Stewart LA. From science to practice: meta-analyses using individual patient data are needed. JAMA 1995; 274: 845-46.
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Language: | English.
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Document Type: | Articles.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0140-6736
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NLM Journal Code: | 2985213r, l0s, 0053266
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Annotation(s) | |