TY - JOUR
T1 - Meta-analysis of chemotherapy in head and neck cancer (MACH-NC)
T2 - A comprehensive analysis by tumour site
AU - Blanchard, Pierre
AU - Baujat, Bertrand
AU - Holostenco, Victoria
AU - Bourredjem, Abderrahmane
AU - Baey, Charlotte
AU - Bourhis, Jean
AU - Pignon, Jean Pierre
N1 - Funding Information:
The chief acknowledgement is to the trialists who agreed to share their data. We also thank the following institutions for funding the investigators meeting or the meta-analysis project: Association pour la Recherche sur le Cancer (ARC No. 2015 ), Institut Gustave-Roussy, Ligue Nationale Contre le Cancer, Programme Hospitalier de Recherche Clinique (No. IDF 95009 ), Sanofi-Aventis.
PY - 2011/7/1
Y1 - 2011/7/1
N2 - Introduction: The recently updated meta-analysis of chemotherapy in head and neck cancer (MACH-NC) demonstrated the benefit of the addition of chemotherapy in terms of overall survival in head and neck squamous cell carcinoma (HNSCC). The magnitude of the benefit according to tumour site is unknown as well as their potential interactions with patient or trial characteristics. Methods: Eighty seven randomized trials performed between 1965 and 2000 were included in the present analysis. Patients were divided into four categories according to tumour location: oral cavity, oropharynx, hypopharynx and larynx. Patients with other tumour location were excluded (999, 5.7%). For each tumour location and chemotherapy timing, the logrank-test, stratified by trial, was used to compare treatments. The hazard ratios of death or relapse were calculated. Interactions between patient or trial characteristics and chemotherapy effect were studied. Results: Individual patient data of 16,192 patients were analysed, with a median follow-up of 5.6 years. The benefit of the addition is consistent in all tumour locations, with hazard ratios between 0.87 and 0.88 (p-value of interaction = 0.99). Chemotherapy benefit was higher for concomitant administration for all tumour locations, but the interaction test between chemotherapy timing and treatment effect was only significant for oropharyngeal (p < 0.0001) and laryngeal tumours (p = 0.05), and not for oral cavity (p = 0.15) and hypopharyngeal tumours (p = 0.30). The 5-year absolute benefits associated with the concomitant chemotherapy are 8.9%, 8.1%, 5.4% and 4% for oral cavity, oropharynx, larynx and hypopharynx tumours, respectively. Conclusion: The benefit of the addition of chemotherapy to locoregional treatment is consistent in all tumour locations of HNSCC. The higher benefit of concomitant schedule was demonstrated only for oropharyngeal and laryngeal tumours but this may be only a consequence of a lack of power.
AB - Introduction: The recently updated meta-analysis of chemotherapy in head and neck cancer (MACH-NC) demonstrated the benefit of the addition of chemotherapy in terms of overall survival in head and neck squamous cell carcinoma (HNSCC). The magnitude of the benefit according to tumour site is unknown as well as their potential interactions with patient or trial characteristics. Methods: Eighty seven randomized trials performed between 1965 and 2000 were included in the present analysis. Patients were divided into four categories according to tumour location: oral cavity, oropharynx, hypopharynx and larynx. Patients with other tumour location were excluded (999, 5.7%). For each tumour location and chemotherapy timing, the logrank-test, stratified by trial, was used to compare treatments. The hazard ratios of death or relapse were calculated. Interactions between patient or trial characteristics and chemotherapy effect were studied. Results: Individual patient data of 16,192 patients were analysed, with a median follow-up of 5.6 years. The benefit of the addition is consistent in all tumour locations, with hazard ratios between 0.87 and 0.88 (p-value of interaction = 0.99). Chemotherapy benefit was higher for concomitant administration for all tumour locations, but the interaction test between chemotherapy timing and treatment effect was only significant for oropharyngeal (p < 0.0001) and laryngeal tumours (p = 0.05), and not for oral cavity (p = 0.15) and hypopharyngeal tumours (p = 0.30). The 5-year absolute benefits associated with the concomitant chemotherapy are 8.9%, 8.1%, 5.4% and 4% for oral cavity, oropharynx, larynx and hypopharynx tumours, respectively. Conclusion: The benefit of the addition of chemotherapy to locoregional treatment is consistent in all tumour locations of HNSCC. The higher benefit of concomitant schedule was demonstrated only for oropharyngeal and laryngeal tumours but this may be only a consequence of a lack of power.
KW - Chemotherapy
KW - Head and neck cancer
KW - Hypopharynx
KW - Individual patient data
KW - Larynx
KW - Meta-analysis
KW - Oral cavity
KW - Oropharynx
KW - Radiotherapy
KW - Randomized clinical trials
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=80051789292&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2011.05.036
DO - 10.1016/j.radonc.2011.05.036
M3 - Article
C2 - 21684027
AN - SCOPUS:80051789292
SN - 0167-8140
VL - 100
SP - 33
EP - 40
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 1
ER -