Adjuvant cisplatin regimens for locoregionally advanced head and neck squamous cell carcinoma: A meta-analysis.

Abstract

e18121 Background: The optimal postoperative cisplatin dosing schedule for locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) remains uncertain. This meta-analysis compares weekly, three-weekly, and other regimens in terms of overall survival (OS), progression-free survival (PFS), locoregional control (LRC), and treatment-related toxicities. Methods: A systematic review of PubMed, Web of Science, and Cochrane databases identified 14 studies with a total of 2,340 patients. Among them, 1,155 patients received weekly cisplatin, 966 patients were treated with a three-weekly schedule, and 219 patients received other dosing regimens. Pooled proportions at endline with 95 percent confidence intervals (CIs) were calculated using a random-effects model, and heterogeneity was assessed using the I² statistic. Results: The pooled OS proportion for weekly cisplatin was 54.9% (95% CI: 51.2–58.5), with a median OS (mOS) of 38.8 months (IQR: 6.88), showing significant heterogeneity (I² = 94.1%). The 3-weekly regimen had a higher OS of 64.4% (95% CI: 57.7–70.5), mOS of 27 months (IQR: 2.5), and no heterogeneity (I² = 0.0%; P = 0.02). PFS for weekly cisplatin was 51.1% (95% CI: 47.2–54.9), mPFS of 20.28 months (IQR: 2.15), while the 3-weekly regimen achieved 45.4% (95% CI: 40.7–50.2), mPFS of 24 months (IQR: 3.3; P = 0.08). LRC was 46.4% (95% CI: 41.6–51.3) for weekly cisplatin. Xerostomia was significantly higher with weekly cisplatin at 55.8% (95% CI: 51.6–59.9; P < 0.01). Dysphagia was also more frequent at 37.1% (95% CI: 33.1–41.2; P = 0.04). Ototoxicity rates were low in both groups, with the weekly regimen showing 4.0% (95% CI: 2.7–6.0; P = 0.25). Conclusions: The 3-weekly cisplatin regimen was associated with significantly improved OS and LRC compared to weekly cisplatin in the postoperative setting for SCCHN. However, the weekly regimen was associated with a higher incidence of treatment-related toxicities, such as xerostomia and dysphagia. Further prospective studies are warranted to establish the optimal postoperative cisplatin dosing schedule. Meta-analytical of cisplatin regimens and outcomes. Regimen Number of Studies Patients (N) Cisplatin Dose and Schedule OS (%, 95% CI) PFS (%, 95% CI) LRC (%, 95% CI) Dysphagia (%, 95% CI) Xerostomia (%, 95% CI) Weekly 7 1155 40 mg/m² weekly during radiotherapy 54.9 [51.2–58.5] 51.1 [47.2–54.9] 46.4 [41.6–51.3] 37.1 [33.1–41.2] 55.8 [51.6–59.9] 3-Weekly 5 966 100 mg/m² every 3 weeks during radiotherapy 64.4 [57.7–70.5] 45.4 [40.7–50.2] 56.5 [49.8–62.9] 26.7 [19.3–35.2] 48.2 [41.5–55.0] Others 2 219 Variable doses (daily/fractionated high-dose) 61.7 [46.4–75.5] 58.8 [11.2–94.2] 52.3 [7.7–93.5] - -