Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group

作者：Benjamin Lacas, Alexandra Carmel, C. Landais, Stuart J. Wong, Lisa Francesca Licitra, Jeffrey S. Tobias, Barbara Ann Burtness, Maria Grazia Ghi, Ezra E.W. Cohen, Cai Grau, Gregory T. Wolf, Ricardo Hitt, Renzo Corvò, Volker Budach, Shaleen Kumar, Sarbani Ghosh Laskar, Jean‐Jacques Mazeron, Lai‐ping Zhong, Werner Dobrowsky, Pirus Ghadjar, Carlo Fallai, Branko Zakotnik, Atul Sharma, René‐Jean Bensadoun, Maria Grazia Ruo Redda, S. Racadot, George Fountzilas, David M. Brizel, Paolo Rovea, Athanassios E. Argiris, Zoltán Takácsi Nagy, Ju‐Whei Lee, Catherine Fortpied, Jonathan Harris, Jean Bourhis, Anne Aupérin, Pierre Blanchard, Jean‐Pierre Pignon, David J. Adelstein, M. Alfonsi, Y. Belkacemi, Voichita Bar‐Ad, J. Bernier, Åse Bratland, G. Calais, Brittany B. Campbell, Jimmy J. Caudell, Sylvie Chabaud, Emmanuel Chamorey, Devendra A. Chaukar, Kwang Nam Choi, O. Choussy, Laurence Collette, Judith Cruz, Carla Dani, Etienne Dauzier, Arlene A. Forastiere, P. Garaud, Valérie Grégoire, Alan Hackshaw, E. Haddad, Bruce George Haffty, Aaron Richard Hansen, Stefanie Hayoz, Jean-Claude Horiot, Branislav M. Jeremic, Theodore G Karrison, Johannes Albertus Langendijk, M. Lapeyre, Eric Felix Lartigau, Traci L. Leong, Quynh‐Thu Le, Patricia Lee, Freddi Lewin, Aihua Lin, Alberto Lopes, Samir P. Mehta, James Moon, Elizabeth Moyal, Bob‐Valéry Occéan, P. Olmi, Roberto Orecchia, Brian P O'Sullivan, Jens Overgaard, Claire Petit, Harvey Charles Quon, Giuseppe Sanguineti, Tuvana Satar, John R. Simes, Christian Simon, Clément Sire, S. Staar, C. Stromberger, P. Strojan, Stéphane Temam, David J Thomson, A. Timochenko, Valter Torri, Vassilikì Tseroni, Jan Baptist Vermorken, Everett E. Vokes, John N. Waldron, Klaus‐Dieter Wernecke, Joachim Widder, Björn Zackrisson · 发表于：Radiotherapy and Oncology · 年份：2021 · DOI：10.1016/j.radonc.2021.01.013 · 被引用次数：392 · 研究领域：Head and Neck Cancer Studies、Esophageal Cancer Research and Treatment、Head and Neck Surgical Oncology

BACKGROUND AND PURPOSE: The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. MATERIALS AND METHODS: Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. RESULTS: For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question,...