Background: Cisplatin-based chemoradiotherapy is the standard treatment for locally advanced head and neck squamous-cell carcinoma (LA-HNSCC); however, the optimal dosing regimen remains debated. This systematic review and meta-analysis aimed to compare treatment compliance, therapeutic efficacy, and toxicity profiles between weekly (30–50 mg/m2) and triweekly (100 mg/m2every three weeks) cisplatin regimens in patients receiving concurrent radiotherapy for LA-HNSCC. Methods: A systematic literature search was conducted in PubMed, Google Scholar, and ClinicalTrials.gov to identify prospective clinical trials published before 16 January 2025, comparing weekly and triweekly cisplatin regimens. Studies were included if they reported treatment compliance, efficacy, and chemotherapy-related toxicities. Single-arm studies were excluded. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias (RoB) tool. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the primary endpoints: overall survival (OS) and chemotherapy completion rates. Heterogeneity was assessed using the I2statistic. Results: Fifteen prospective clinical trials with 1572 patients (775 weekly and 797 triweekly) were included. Treatment compliance was similar between the regimens, with 74.76% (weekly) vs. 72.29% (triweekly) completing chemotherapy (p= 0.38). The mean cumulative cisplatin dose was significantly higher in the triweekly regimen (287.52 mg/m2vs. 241.74 mg/m2,p= 0.04); however, the proportion of patients receiving a cumulative dose ≥200 mg/m2did not differ significantly (p= 0.23). The therapeutic efficacy was comparable, with complete response rates of 63.18% (weekly) and 67.13% (triweekly) (p= 0.32) and OS rates at 2 years of 51.24% and 49.47% (p= 0.45). No significant differences were observed in the toxicity rates (any grade or grade ≥ 3) or mortality. The I2statistic indicated insignificant heterogeneity across the studies. Interpretation: The results do not provide definitive evidence favoring one regimen over the other. Both regimens remain viable treatment options with comparable efficacy and adherence. Treatment selection should be individualized, considering toxicity risk, patient tolerability, and clinical factors.
背景：以顺铂为基础的同步放化疗是局部晚期头颈部鳞状细胞癌（LA-HNSCC）的标准治疗方案，但其最佳给药方案仍存在争议。本系统综述与荟萃分析旨在比较LA-HNSCC患者接受同步放疗时，每周（30–50 mg/m²）与三周一次（每三周100 mg/m²）顺铂方案在治疗依从性、疗效及毒性特征方面的差异。 方法：系统检索了PubMed、Google Scholar和ClinicalTrials.gov数据库中截至2025年1月16日发表的前瞻性临床试验，这些研究比较了每周与三周一次顺铂方案。纳入标准为报告治疗依从性、疗效及化疗相关毒性的研究，排除单臂研究。由两名评审员独立进行数据提取，并使用Cochrane偏倚风险（RoB）工具评估偏倚风险。主要终点为总生存期（OS）和化疗完成率，计算其比值比（OR）及95%置信区间（CI）。采用I²统计量评估异质性。 结果：共纳入15项前瞻性临床试验，涉及1572例患者（每周方案775例，三周方案797例）。两种方案的治疗依从性相似，化疗完成率分别为74.76%（每周方案）和72.29%（三周方案）（p=0.38）。三周方案的平均累积顺铂剂量显著更高（287.52 mg/m² vs. 241.74 mg/m²，p=0.04），但累积剂量≥200 mg/m²的患者比例无显著差异（p=0.23）。疗效相当：完全缓解率分别为63.18%（每周方案）和67.13%（三周方案）（p=0.32），2年OS率分别为51.24%和49.47%（p=0.45）。在毒性发生率（任何级别或≥3级）及死亡率方面均未观察到显著差异。I²统计量提示各研究间异质性不显著。 结论：结果未能提供明确证据支持某一方案优于另一方案。两种方案均是可行的治疗选择，具有相当的疗效和依从性。治疗方案的选择应个体化，综合考虑毒性风险、患者耐受性及临床因素。
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