Postoperative chemoradiotherapy for advanced squamous cell carcinoma of the head and neck: a systematic review with meta-analysis.

BACKGROUND This systematic review evaluates the use of postoperative chemoradiotherapy for patients with advanced (stage III or IV) squamous cell carcinoma of the head and neck at a high risk of recurrence. METHODS The literature was systematically searched for eligible randomized controlled trials (RCTs). RESULTS Of 4 RCTs identified, 3 reported improvements in locoregional control, 3 reported improved disease-free or progression-free survival, and 3 reported improved overall survival with chemoradiotherapy compared with radiotherapy alone. Pooling trials confirmed the benefit for chemoradiotherapy in locoregional recurrence (relative risk [RR] = 0.59; 95% confidence interval [CI] = 0.47-0.75; p < .00001) and overall survival (RR = 0.80; 95% CI = 0.71-0.90; p = .0002). More frequent and severe acute mucosal toxicity was reported with combined treatment. CONCLUSIONS Postoperative adjuvant chemoradiotherapy is superior to radiotherapy alone. Because chemoradiotherapy is associated with significantly increased toxicity, further investigations to identify patients most likely to benefit or toxicity reduction strategies are warranted.