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Synergistic Kill Capability of Combining Standard Chemotherapy and Radiotherapy for Head and Neck Cancer: A Systematic Review and Meta-Analysis.
Radiotherapy (RT) alone has greatly reduced local control for head and neck squamous cell carcinoma (HNSCC). However, the combination of concurrent RT with chemotherapy (CCRT) has not markedly improved disease-free survival. Here, we reviewed the efficacy of CCRT versus chemotherapy alone in patients with HNSCC, and further tested whether the added RT benefit was retained in patients treated with CCRT. We systematically searched the PubMed, EMBASE, and Cochrane Library databases for all relevant studies, including randomized controlled trials comparing CCRT plus radiotherapy (RT) vs RT alone. Outcomes reported included overall survival (OS) and disease-free survival. Subgroup analyses explored the effects of several potentially relevant factors. Nine studies (n = 1713) with eight comparisons and nine comparisons were included in the systematic review and meta-analysis, respectively. In patients treated with RT alone, 2-year OS was 69.6% and 2-year disease-free survival (DFS) was 54.4%. In patients receiving CCRT, OS was 78.1% and DFS was 70.9%. Based on fixed- and random-effects models, significant improvements in OS (HR, 0.56; 95% CI, 0.47-0.67; P = 0.000) and DFS (HR, 0.73; 95% CI, 0.63-0.87; P = 0.000) were identified in patients treated with CCRT compared with RT alone. Subgroup analysis revealed that the significant improvement in OS was also observed in patients who received RT with CCRT compared with those who received RT alone. The potential benefit of CCRT was also identified in patients treated with RT only or with chemotherapy plus either cisplatin or taxane or RT combined with the two. These data indicate that the routine use of CCR