Induction Chemotherapy Followed By Concurrent Chemoradiotherapy Versus Concurrent Chemoradiotherapy Alone As Treatment Of Locally Advanced Squamous Cell Carcinoma Of The Head And Neck(HNSCC):A Meta-analysis Of Randomized Trials

Objective: To systematically review the efficacy and safety of induction chemotherapy before concurrent chemoradiotherapy or not.Method:We comprehensively searched the CBM,Pubmed,EMBASE,and the Cochrane databases to identify published studies.Quality assessment of RCTs was conducted according to the methods of Cochrane collaboration.Data extraction and quality assessment of included studies were conducted by two reviewers independently.A meta-analysis was performed by using the Revman 5.3 software.Primary outcomes included overall survival(OS),progression-free survival(PFS)and overall response rate(ORR).Seriousadverse events include neutropenia,anemia,skinreactions,vomiting,etc.Results:A total 6 randomized controlled trials involving 1141 patients were included.There was no significant difference in 1-year survival rate,2-year survival rate,3-year survival rate,5-year survival rate between the two groups(RR =1.05,95%CI:0.97-1.14,P=0.25;RR =0.97,95%CI: 0.85-1.11,P =0.71;RR =0.96,95%CI: 0.82-1.13,P =0.66;RR=0.95,95%CI:0.71-1.27,P =0.71,respectively).The 1-year PFS,2-year PFS,3-year PFS,5-year PFS,ORR also showed no difference between the two cohorts.However,the incidence of grade 3 to 4 febrile neutropenia and oral mucositis was higher in the group of induction chemotherapy followed by concurrent chemoradiotherapy.Conclusions:Additional induction chemotherapy before concurrent chemoradiotherapy does not improve OS and PFS in locally advanced HNSCC compared to concurrent chemoradiotherapy alone,and can cause a higher incidence of adverse events.