Effect of amifostine in head and neck cancer patients treated with radiotherapy: a systematic review and meta-analysis based on randomized controlled trials
Amifostine is the most clinical used chemical radioprotector, but its effect in patients treated with radiation is not consistent. By searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patien...
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description | Amifostine is the most clinical used chemical radioprotector, but its effect in patients treated with radiation is not consistent.
By searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patients treated with radiotherapy were collected. The pooled efficacy and side effects of this drug were calculated by RevMan software.
Seventeen trials including a total of 1167 patients (604 and 563 each arm) were analyzed in the meta-analysis. The pooled data showed that the use of amifostine significantly reduce the risk of developing Grade 3-4 mucositis (relative risk [RR],0.72; 95% confidence interval [CI],0.54-0.95; p |
doi_str_mv | 10.1371/journal.pone.0095968 |
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By searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patients treated with radiotherapy were collected. The pooled efficacy and side effects of this drug were calculated by RevMan software.
Seventeen trials including a total of 1167 patients (604 and 563 each arm) were analyzed in the meta-analysis. The pooled data showed that the use of amifostine significantly reduce the risk of developing Grade 3-4 mucositis (relative risk [RR],0.72; 95% confidence interval [CI],0.54-0.95; p<0.00001), Grade 2-4 acute xerostomia (RR,0.70; 95%CI,0.52-0.96; p = 0.02), or late xerostomia (RR,0.60; 95%CI,0.49-0.74; p<0.00001) and Grade 3-4 dysphagia (RR,0.39; 95%CI,0.17-0.92; p = 0.03). However, subgroup analysis demonstrated that no statistically significant reduction of Grade 3-4 mucositis (RR,0.97; 95% CI,0.74-1.26; p = 0.80), Grade 2-4 acute xerostomia (RR,0.35; 95%CI,0.02-5.44; p = 0.45), or late xerostomia (RR,0.40; 95%CI,0.13-1.24; p = 0.11) and Grade 3-4 dysphagia (RR,0.23; 95%CI,0.01-4.78; p = 0.35) was observed in patients treated with concomitant chemoradiotherapy. Compared with placebo or observation, amifostine does not show tumor protective effect in complete response (RR,1.02; 95%CI,0.89-1.17; p = 0.76) and partial response (RR,0.90; 95%CI, 0.56-1.44; p = 0.66). For the hematologic side effect, no statistical difference of Grade 3-4 leucopenia (RR,0.60; 95%CI,0.35-1.05; p = 0.07), anemia (RR,0.80; 95%CI, 0.42-1.53; p = 0.50) and thrombocytopenia (RR,0.43; 95%CI,0.16-1.15; p = 0.09) were found between amifostine and control groups. The most common amifostine related side effects were nausea, emesis, hypotension and allergic with an average incidence rate (Grade 3-4) of 5%, 6%, 4% and 4% respectively.
This systematic review showed that amifostine significantly reduce the serious mucositis, acute/late xerastomia and dysphagia without protection of the tumor in HNSCC patients treated with radiotherapy. And the toxicities of amifostine were generally acceptable.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0095968</identifier><identifier>PMID: 24788761</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Amifostine ; Amifostine - pharmacology ; Amifostine - therapeutic use ; Analysis ; Anemia ; Cancer ; Cancer patients ; Cancer therapies ; Carcinoma, Squamous Cell - drug therapy ; Carcinoma, Squamous Cell - radiotherapy ; Care and treatment ; Chemoradiotherapy ; Clinical trials ; Combined Modality Therapy ; Confidence intervals ; Data processing ; Dysphagia ; Handbooks ; Head & neck cancer ; Head and neck cancer ; Head and Neck Neoplasms - drug therapy ; Head and Neck Neoplasms - radiotherapy ; Hematology ; Humans ; Hypotension ; Laboratories ; Leukopenia ; Lung cancer ; Medicine and Health Sciences ; Meta-analysis ; Metastasis ; Mucositis ; Nausea ; Oncology ; Patients ; Radiation ; Radiation Injuries - prevention & control ; Radiation therapy ; Radiotherapy ; Randomization ; Randomized Controlled Trials as Topic - methods ; Researchers ; Side effects ; Squamous cell carcinoma ; Squamous Cell Carcinoma of Head and Neck ; Statistical analysis ; Studies ; Systematic review ; Thrombocytopenia ; Toxicity ; Vomiting ; Xerostomia</subject><ispartof>PloS one, 2014-05, Vol.9 (5), p.e95968</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Gu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Gu et al 2014 Gu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-b2db61043764cdbd50d3b0f9b0e75255557087e61322ac0836a8019724e045273</citedby><cites>FETCH-LOGICAL-c692t-b2db61043764cdbd50d3b0f9b0e75255557087e61322ac0836a8019724e045273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008569/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008569/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24788761$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Gires, Olivier</contributor><creatorcontrib>Gu, Jundong</creatorcontrib><creatorcontrib>Zhu, Siwei</creatorcontrib><creatorcontrib>Li, Xuebing</creatorcontrib><creatorcontrib>Wu, Hua</creatorcontrib><creatorcontrib>Li, Yang</creatorcontrib><creatorcontrib>Hua, Feng</creatorcontrib><title>Effect of amifostine in head and neck cancer patients treated with radiotherapy: a systematic review and meta-analysis based on randomized controlled trials</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Amifostine is the most clinical used chemical radioprotector, but its effect in patients treated with radiation is not consistent.
By searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patients treated with radiotherapy were collected. The pooled efficacy and side effects of this drug were calculated by RevMan software.
Seventeen trials including a total of 1167 patients (604 and 563 each arm) were analyzed in the meta-analysis. The pooled data showed that the use of amifostine significantly reduce the risk of developing Grade 3-4 mucositis (relative risk [RR],0.72; 95% confidence interval [CI],0.54-0.95; p<0.00001), Grade 2-4 acute xerostomia (RR,0.70; 95%CI,0.52-0.96; p = 0.02), or late xerostomia (RR,0.60; 95%CI,0.49-0.74; p<0.00001) and Grade 3-4 dysphagia (RR,0.39; 95%CI,0.17-0.92; p = 0.03). However, subgroup analysis demonstrated that no statistically significant reduction of Grade 3-4 mucositis (RR,0.97; 95% CI,0.74-1.26; p = 0.80), Grade 2-4 acute xerostomia (RR,0.35; 95%CI,0.02-5.44; p = 0.45), or late xerostomia (RR,0.40; 95%CI,0.13-1.24; p = 0.11) and Grade 3-4 dysphagia (RR,0.23; 95%CI,0.01-4.78; p = 0.35) was observed in patients treated with concomitant chemoradiotherapy. Compared with placebo or observation, amifostine does not show tumor protective effect in complete response (RR,1.02; 95%CI,0.89-1.17; p = 0.76) and partial response (RR,0.90; 95%CI, 0.56-1.44; p = 0.66). For the hematologic side effect, no statistical difference of Grade 3-4 leucopenia (RR,0.60; 95%CI,0.35-1.05; p = 0.07), anemia (RR,0.80; 95%CI, 0.42-1.53; p = 0.50) and thrombocytopenia (RR,0.43; 95%CI,0.16-1.15; p = 0.09) were found between amifostine and control groups. The most common amifostine related side effects were nausea, emesis, hypotension and allergic with an average incidence rate (Grade 3-4) of 5%, 6%, 4% and 4% respectively.
This systematic review showed that amifostine significantly reduce the serious mucositis, acute/late xerastomia and dysphagia without protection of the tumor in HNSCC patients treated with radiotherapy. And the toxicities of amifostine were generally acceptable.</description><subject>Amifostine</subject><subject>Amifostine - pharmacology</subject><subject>Amifostine - therapeutic use</subject><subject>Analysis</subject><subject>Anemia</subject><subject>Cancer</subject><subject>Cancer patients</subject><subject>Cancer therapies</subject><subject>Carcinoma, Squamous Cell - drug therapy</subject><subject>Carcinoma, Squamous Cell - radiotherapy</subject><subject>Care and treatment</subject><subject>Chemoradiotherapy</subject><subject>Clinical trials</subject><subject>Combined Modality Therapy</subject><subject>Confidence intervals</subject><subject>Data processing</subject><subject>Dysphagia</subject><subject>Handbooks</subject><subject>Head & neck cancer</subject><subject>Head and neck cancer</subject><subject>Head and Neck Neoplasms - drug therapy</subject><subject>Head and Neck Neoplasms - radiotherapy</subject><subject>Hematology</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Laboratories</subject><subject>Leukopenia</subject><subject>Lung cancer</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Metastasis</subject><subject>Mucositis</subject><subject>Nausea</subject><subject>Oncology</subject><subject>Patients</subject><subject>Radiation</subject><subject>Radiation Injuries - prevention & control</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Randomization</subject><subject>Randomized Controlled Trials as Topic - methods</subject><subject>Researchers</subject><subject>Side effects</subject><subject>Squamous cell carcinoma</subject><subject>Squamous Cell Carcinoma of Head and Neck</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Systematic review</subject><subject>Thrombocytopenia</subject><subject>Toxicity</subject><subject>Vomiting</subject><subject>Xerostomia</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11rFDEUhgdRrFb_gWhAELzYNR8zyYwXQilVC4WCX7fhTHJmN3UmWZNs6_pb_LGm7bZ0QcGZi2Qyz_vOOyc5VfWM0TkTir05C-voYZyvgsc5pV3TyfZe9Yh1gs8kp-L-nfle9TilM0ob0Ur5sNrjtWpbJdmj6vfRMKDJJAwEJjeElJ1H4jxZIlgC3hKP5jsx4A1GsoLs0OdEckTIaMmFy0sSwbqQlxhhtXlLgKRNyjgV1JCI5w4vrnwmzDCDkniTXCI9pCIPvoi9DZP7VZ5M8DmGcSzTHB2M6Un1YCgDPt2O-9XX90dfDj_OTk4_HB8enMyM7Hie9dz2ktFaKFkb29uGWtHToespqoY35VK0VSiZ4BwMbYWElrJO8Rpp3XAl9qsX176rMSS9LWzSrOG0UZwLUYjja8IGONOr6CaIGx3A6auFEBcaYvnhEXUPkvWmV00NpqZt2zHOBG27kouVFLZ4vdt-bd1PaE0paIRxx3T3jXdLvQjnuqa0bWRXDF5uDWL4scaU_xF5Sy2gpHJ-CMXMTC4ZfVAzqZSSrSzU_C9UuS1OrmwIDq6s7whe7wguNw1_5gWsU9LHnz_9P3v6bZd9dYctp2_MyxTGdXbBp12wvgZNDClFHG4rx6i-7IybaujLztDbziiy53erfiu6aQXxB1K2Cqs</recordid><startdate>20140502</startdate><enddate>20140502</enddate><creator>Gu, Jundong</creator><creator>Zhu, Siwei</creator><creator>Li, Xuebing</creator><creator>Wu, Hua</creator><creator>Li, Yang</creator><creator>Hua, Feng</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20140502</creationdate><title>Effect of amifostine in head and neck cancer patients treated with radiotherapy: a systematic review and meta-analysis based on randomized controlled trials</title><author>Gu, Jundong ; Zhu, Siwei ; Li, Xuebing ; Wu, Hua ; Li, Yang ; Hua, Feng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-b2db61043764cdbd50d3b0f9b0e75255557087e61322ac0836a8019724e045273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Amifostine</topic><topic>Amifostine - pharmacology</topic><topic>Amifostine - therapeutic use</topic><topic>Analysis</topic><topic>Anemia</topic><topic>Cancer</topic><topic>Cancer patients</topic><topic>Cancer therapies</topic><topic>Carcinoma, Squamous Cell - drug therapy</topic><topic>Carcinoma, Squamous Cell - radiotherapy</topic><topic>Care and treatment</topic><topic>Chemoradiotherapy</topic><topic>Clinical trials</topic><topic>Combined Modality Therapy</topic><topic>Confidence intervals</topic><topic>Data processing</topic><topic>Dysphagia</topic><topic>Handbooks</topic><topic>Head & neck cancer</topic><topic>Head and neck cancer</topic><topic>Head and Neck Neoplasms - drug therapy</topic><topic>Head and Neck Neoplasms - radiotherapy</topic><topic>Hematology</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Laboratories</topic><topic>Leukopenia</topic><topic>Lung cancer</topic><topic>Medicine and Health Sciences</topic><topic>Meta-analysis</topic><topic>Metastasis</topic><topic>Mucositis</topic><topic>Nausea</topic><topic>Oncology</topic><topic>Patients</topic><topic>Radiation</topic><topic>Radiation Injuries - prevention & control</topic><topic>Radiation therapy</topic><topic>Radiotherapy</topic><topic>Randomization</topic><topic>Randomized Controlled Trials as Topic - methods</topic><topic>Researchers</topic><topic>Side effects</topic><topic>Squamous cell carcinoma</topic><topic>Squamous Cell Carcinoma of Head and Neck</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>Systematic review</topic><topic>Thrombocytopenia</topic><topic>Toxicity</topic><topic>Vomiting</topic><topic>Xerostomia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gu, Jundong</creatorcontrib><creatorcontrib>Zhu, Siwei</creatorcontrib><creatorcontrib>Li, Xuebing</creatorcontrib><creatorcontrib>Wu, Hua</creatorcontrib><creatorcontrib>Li, Yang</creatorcontrib><creatorcontrib>Hua, Feng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gu, Jundong</au><au>Zhu, Siwei</au><au>Li, Xuebing</au><au>Wu, Hua</au><au>Li, Yang</au><au>Hua, Feng</au><au>Gires, Olivier</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of amifostine in head and neck cancer patients treated with radiotherapy: a systematic review and meta-analysis based on randomized controlled trials</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-05-02</date><risdate>2014</risdate><volume>9</volume><issue>5</issue><spage>e95968</spage><pages>e95968-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Amifostine is the most clinical used chemical radioprotector, but its effect in patients treated with radiation is not consistent.
By searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patients treated with radiotherapy were collected. The pooled efficacy and side effects of this drug were calculated by RevMan software.
Seventeen trials including a total of 1167 patients (604 and 563 each arm) were analyzed in the meta-analysis. The pooled data showed that the use of amifostine significantly reduce the risk of developing Grade 3-4 mucositis (relative risk [RR],0.72; 95% confidence interval [CI],0.54-0.95; p<0.00001), Grade 2-4 acute xerostomia (RR,0.70; 95%CI,0.52-0.96; p = 0.02), or late xerostomia (RR,0.60; 95%CI,0.49-0.74; p<0.00001) and Grade 3-4 dysphagia (RR,0.39; 95%CI,0.17-0.92; p = 0.03). However, subgroup analysis demonstrated that no statistically significant reduction of Grade 3-4 mucositis (RR,0.97; 95% CI,0.74-1.26; p = 0.80), Grade 2-4 acute xerostomia (RR,0.35; 95%CI,0.02-5.44; p = 0.45), or late xerostomia (RR,0.40; 95%CI,0.13-1.24; p = 0.11) and Grade 3-4 dysphagia (RR,0.23; 95%CI,0.01-4.78; p = 0.35) was observed in patients treated with concomitant chemoradiotherapy. Compared with placebo or observation, amifostine does not show tumor protective effect in complete response (RR,1.02; 95%CI,0.89-1.17; p = 0.76) and partial response (RR,0.90; 95%CI, 0.56-1.44; p = 0.66). For the hematologic side effect, no statistical difference of Grade 3-4 leucopenia (RR,0.60; 95%CI,0.35-1.05; p = 0.07), anemia (RR,0.80; 95%CI, 0.42-1.53; p = 0.50) and thrombocytopenia (RR,0.43; 95%CI,0.16-1.15; p = 0.09) were found between amifostine and control groups. The most common amifostine related side effects were nausea, emesis, hypotension and allergic with an average incidence rate (Grade 3-4) of 5%, 6%, 4% and 4% respectively.
This systematic review showed that amifostine significantly reduce the serious mucositis, acute/late xerastomia and dysphagia without protection of the tumor in HNSCC patients treated with radiotherapy. And the toxicities of amifostine were generally acceptable.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24788761</pmid><doi>10.1371/journal.pone.0095968</doi><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1932-6203 |
ispartof | PloS one, 2014-05, Vol.9 (5), p.e95968 |
issn | 1932-6203 1932-6203 |
language | eng |
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source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
subjects | Amifostine Amifostine - pharmacology Amifostine - therapeutic use Analysis Anemia Cancer Cancer patients Cancer therapies Carcinoma, Squamous Cell - drug therapy Carcinoma, Squamous Cell - radiotherapy Care and treatment Chemoradiotherapy Clinical trials Combined Modality Therapy Confidence intervals Data processing Dysphagia Handbooks Head & neck cancer Head and neck cancer Head and Neck Neoplasms - drug therapy Head and Neck Neoplasms - radiotherapy Hematology Humans Hypotension Laboratories Leukopenia Lung cancer Medicine and Health Sciences Meta-analysis Metastasis Mucositis Nausea Oncology Patients Radiation Radiation Injuries - prevention & control Radiation therapy Radiotherapy Randomization Randomized Controlled Trials as Topic - methods Researchers Side effects Squamous cell carcinoma Squamous Cell Carcinoma of Head and Neck Statistical analysis Studies Systematic review Thrombocytopenia Toxicity Vomiting Xerostomia |
title | Effect of amifostine in head and neck cancer patients treated with radiotherapy: a systematic review and meta-analysis based on randomized controlled trials |
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