Meta.

Top Line: Decades of trials have demonstrated that hyperfractionation improves survival for head and neck cancers over conventional fractionation, and chemo concurrent to conventional fractionation is best of all...but shouldn’t chemo concurrent to hyperfractionation really be best of all?

The Study: Today we bring you a meta-analysis of meta-analyses. Whaaaat. That’s right, a combined look at MARCH and MACH comprising nearly 29K patients treated between 1980-2016. The sheer amount of comparisons that can be made with this data is eye-crossing so shout-out to the biostaticians on this one. But guess what. Chemo concurrent with hyperfractionated radiation was ultimately determined to be associated with the best overall survival of all with a hazard ratio (HR) of 0.63 when compared to the benchmark of conventional radiation alone. Yes, it even demonstrated a significant advantage (HR 0.82) over the reigning regimen of cisplatin-based chemo concurrent with conventional fractionation. What’s more, it remained superior on virtually all predefined subset analyses. Unfortunately, there wasn’t a great way to compare toxicities across trials.

TBL: Who’s up for designing a modern prospective trial comparing hyperfractionated versus conventionally fractionated radiation with concurrent high-dose cisplatin for head and neck cancers, particularly those that are HPV(-)? | Petit, Lancet Oncol 2021