Comparing efficacy and safety of weekly vs. triweekly cisplatin concurrently with radiotherapy for locally advanced head and neck cancer: Systematic review and meta-analysis

Cisplatin-based chemotherapy is widely used in the treatment of locally advanced head and neck cancer (HNC). The optimal dosing schedule, whether weekly or triweekly, has been a subject of debate. This study aims to evaluate the efficacy and safety of weekly versus triweekly cisplatin regimens in this patient population. In accordance with the PRISMA guidelines, we conducted this meta-analysis to compare outcomes associated with weekly and triweekly cisplatin regimens. The endpoints examined were overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), locoregional recurrence-free survival (LRRFS) and safety. This meta-analysis protocol was registered in PROSPERO (CRD42023461292). The analysis of survival outcomes demonstrated no difference between the two schedules in terms of OS, PFS, LRRFS and DMFS at 2 and 3 years and 5 years (except for 2 years LRRFS). The odds ratio of OS at 2 years was 1.02 (p = 0.87) at 3 years 0.90 (p = 0.46) and at 5 years 1.13 (p = 0.59), and for PFS at the OR 2 years was 0.97 (p = 0.85) at 3 years 0.87 (p = 0.30) and at 5 years 0.86 (p = 0.55). Triweekly was superior to weekly cisplatin in terms of short-term LRRFS (at 2 years), with an OR of 1.57 (p = 0.02). Both protocols were similar in terms of adverse events. Both weekly and triweekly cisplatin regimens show comparable survival outcomes and safety profiles in patients with head and neck cancers, except for short term LRRFS (at 2 years). These findings suggest that treatment decisions should be tailored to the patient's individual profile, including comorbidities and tolerability. Future studies should explore cumulative dosing and biomarkers to refine treatment strategies further. • There is no difference between the two regimens in terms of survival outcomes, except for 2 years LRRFS. • Triweekly was superior to weekly cisplatin protocol at 2 years LRRFS. • There is no difference between the two schedules concerning adverse events. • Treatment decisions should be personalized based on patient profiles, comorbidities, treatment tolerability and preferences.