5505 Background: The MACH-NC Group have previously shown (Lancet; 2000) that chemotherapy (CT) improved survival (4% at 5 years) in non metastatic head and neck squamous cell carcinoma (HNSCC) treated by loco-regional treatment (LRT), with an higher benefit (8%) with CT concomitant to radiotherapy (RT). However the relatively important heterogeneity of the results limited the conclusions and prompted the MACH-NC to further confirm the results, by adding to the data base the data from the randomized trials performed between 1994 and 2000. Methods: Updated individual data from HNSCC patients randomized to LRT versus LRT + CT between 1965 and 2000 were included in this meta-analysis. The logrank-test, stratified by trial, was used for comparison and the hazard ratio (HR) of death was calculated. Results: 24 new trials, most of them on concomitant CT, were included totalizing 87 trials and more than 16,000 patients. The overall pooled HR was 0.88 (p<.0001) with an absolute benefit for CT of 5% at 5-years, and a significant interaction (p<.0001) between CT timing (adjuvant, neoadjuvant or concomitant) and treatment. The following analyses concern only the 50 concomitant trials. For this group, the HR was 0.81 (p<.0001) with an absolute benefit of 8% at 5-years. The results were identical for the 1994–2000 trials and the 1965–1993 trials, but without significant heterogeneity in the recent group. Similar results were obtained in the trials with postoperative RT (HR=0.80), conventional RT (0.83) and altered fractionated RT (0.73). No significant difference was seen between mono-CT (0.84) and poly-CT (0.77). The magnitude of the benefit was higher (p<0.01) for platinum-based CT (0.75) than for other CT (0.86). There was a decreasing effect of CT with age (p=.01). Conclusions: The benefit of concomitant chemotherapy was confirmed and was similar with both definitive and postoperative radiotherapy. The final analysis will be presented at the meeting. Unrestricted grants from ARC, Aventis, PHRC. No significant financial relationships to disclose.
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Bourhis et al. (2004) studied this question.