Title
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Weekly low-dose versus three-weekly high-dose cisplatin for concurrent chemoradiation in locoregionally advanced non-nasopharyngeal head and neck cancer : a systematic review and meta-analysis of aggregate data
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Author
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Abstract
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Background. Three-weekly high-dose cisplatin (100 mg/m(2)) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, due to unsatisfactory patient tolerance, various weekly low-dose schedules have been increasingly used in clinical practice. The aim of this meta-analysis was to compare the efficacy, safety, and compliance between these two approaches. Materials and Methods. We systematically searched literature for prospective trials of patients with LA-SCCHN who received postoperative or definitive conventionally fractionated concurrent chemoradiation. Radiation doses were usually 60-66 gray (Gy) in the postoperative setting and 6670 Gy in the definitive setting. Standard, three-weekly high-dose cisplatin (100 mg/m(2), 3 doses) was compared with the weekly low-dose protocol (<50 mg/m(2), >6 doses). The primary endpoint was overall survival. Secondary outcomes comprised response rate, acute and late adverse events, and treatment compliance. Results. Fifty-two studies with 4,209 patients were included in two separate meta-analyses according to the two clinical settings. There was no difference in treatment efficacy as measured by overall survival or response rate between the chemoradiation settings with low-dose weekly and high-dose three-weekly cisplatin regimens. In the definitive treatment setting, the weekly regimen was more compliant and significantly less toxic with respect to severe (grade 3-4) myelosuppression (leukopenia p = .0083; neutropenia p = .0024), severe nausea and/or vomiting (p < .0001), and severe nephrotoxicity (p = .0099). Although in the postoperative setting the two approaches were more equal in compliance and with clearly less differences in the cisplatin-induced toxicities, the weekly approach induced more grade 3-4 dysphagia (p = .0026) and weight loss (p < .0001). Conclusion. In LA-SCCHN, current evidence is insufficient to demonstrate a meaningful survival difference between the two dosing regimens. Prior to its adoption into routine clinical practice, the low-dose weekly approach needs to be prospectively compared with the standard three-weekly high-dose schedule. |
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Language
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English
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Source (journal)
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The oncologist. - Place of publication unknown
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Publication
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Hoboken
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Wiley
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2017
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ISSN
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1083-7159
[print]
1549-490X
[online]
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DOI
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10.1634/THEONCOLOGIST.2017-0015
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Volume/pages
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22
:9
(2017)
, p. 1056-1066
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ISI
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000410656500009
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Pubmed ID
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28533474
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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