Clinical efficacy of neoadjuvant chemotherapy with platinum-based regimen for patients with locoregionally advanced head and neck squamous cell carcinoma: an evidence-based meta-analysis

BACKGROUND AND OBJECTIVES: As a vital chemotherapeutic modality, the clinical benefits of neoadjuvant chemotherapy still remain uncertain and controversial. The purpose of this meta-analysis was to evaluate the efficacy of neoadjuvant chemotherapy with a platinum-based regimen for patients with locoregional stage III or IV squamous cell carcinoma of the head and neck. DESIGN AND SETTING: Meta-analysis of randomized, controlled trials. METHODS: Relevant randomized controlled trials (RCTs) were identified through systematic search and selected according to the inclusion and exclusion criteria. Eligible RCTs were further analyzed by systematic meta-analysis. Statistical analysis was performed by Review Manager 5.0.21.0 software. RESULTS: A total of 6 RCTs were identified. Pooling effects revealed that there was no statistical significance in locoregional recurrence [relative risk (RR)= 1.06; 95% CI (confidence interval= 0.91-1.24; P>.05], distant metastasis (RR= 0.6; 95% CI= 0.28-1.30; P>.05), disease-free survival (RR= 0.93; 95% CI= 0.75-1.15; P>.05) or overall survival (RR= 0.98; 95% CI= 0.89-1.09; P>.05). More of the common hematological adverse effects were reported with a cisplatin-based regimen. All the studies analyzed in this meta-analysis were individual RCTs with adequate follow-up and relatively narrow confidence intervals, which were classified to the 1b level, and this meta-analysis was classified to the 1a level, according to the Levels of Evidence (March 2009) of Oxford Center for Evidence-based Medicine. CONCLUSIONS: The meta-analysis indicates there is a non-significant difference between neoadjuvant chemotherapeutic treatment and conventional locoregional modality for patients at high risk of recurrence, with regard to overall survival, disease-free survival, distant metastases, and locoregional recurrence. However, well-performed studies of identical platinum-based combinations as neoadjuvant chemotherapeutic regimen are needed for further evaluation.