目的:对于不适合以顺铂为基础的局部晚期头颈部鳞状细胞癌(LAHNSCC)治疗方案的患者,尚无公认的标准选择。因此,我们进行了系统评价,以探索该人群的替代选择.
方法:我们搜索了PubMed,科克伦,和Embase数据库,用于评估LAHNSCC顺铂不合格患者的治疗方案的观察性研究和临床试验(CT)。本研究在PROSPERO注册,编号为CRD42023483156。
结果:本系统综述包括24项研究(18项观察性研究和6项CT),包括4450名LAHNSCC顺铂不合格患者。大多数患者接受西妥昔单抗放疗[RT](50.3%),其次是卡铂RT(31.7%)。在7项报告接受西妥昔单抗-RT治疗的患者的中位总生存期(OS)的研究中,时间为12.8至46个月。在两项评估卡铂-RT的研究中,中位OS优于40个月,在两项单独评估RT的研究中,优于15个月。对于其他方案,如尼妥珠单抗-RT,多西他赛-RT,卡铂-RT联合紫杉醇的中位OS分别为21、25.5和28个月,分别。
结论:我们的系统评价支持对LAHNSCC顺铂不合格患者使用多种治疗组合。我们强调迫切需要评估该人群的治疗方法的临床研究。
OBJECTIVE: There is no agreed-upon standard option for patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC) unfit for cisplatin-based regimens. Therefore, we performed a systematic review to explore alternative options for this population.
METHODS: We searched PubMed, Cochrane, and Embase databases for observational studies and clinical trials (CTs) assessing treatment options for LA HNSCC cisplatin-
ineligible patients. This study was registered in PROSPERO under the number CRD42023483156.
RESULTS: This systematic review included 24 studies (18 observational studies and 6 CTs), comprising 4450 LA HNSCC cisplatin-
ineligible patients. Most patients were treated with cetuximab-radiotherapy [RT] (50.3%), followed by carboplatin-RT (31.7%). In seven studies reporting median overall survival (OS) in patients treated with cetuximab-RT, it ranged from 12.8 to 46 months. The median OS was superior to 40 months in two studies assessing carboplatin-RT, and superior to 15 months in two studies assessing RT alone. For other regimens such as nimotuzumab-RT, docetaxel-RT, and carboplatin-RT plus paclitaxel the median OS was 21, 25.5, and 28 months, respectively.
CONCLUSIONS: Our systematic review supports the use of a variety of therapy combinations for LA HNSCC cisplatin-
ineligible patients. We highlight the urgent need for clinical studies assessing treatment approaches in this population.