Radiotherapy-Chemotherapy Combinations in Locally Advanced Head and Neck Squamous Cell Carcinoma

This network meta-analysis (NMA) evaluated the efficacy and safety of radiotherapy combined with various therapeutic strategies in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Fourteen randomised controlled trials (RCTs) with over 5,900 patients and a minimum two-year follow-up were included. Primary outcomes were overall survival (OS), progression-free survival (PFS), and grade ≥3 toxicities. Bayesian models were used for data synthesis and sensitivity analysis. Pembrolizumab plus radiotherapy (A_V) showed a trend toward improved OS [OR = 1.7, 95% CrI (credible intervals): 0.55-5.6] and PFS (OR = 1.6, 95% CrI: 0.4-6.2) without statistical significance. Toxicity analysis indicated manageable risks for A_V (OR = 0.13, 95% CrI: 0.0095-1.6), while radiotherapy with cisplatin and immunotherapy (A_I_V) showed higher toxicity (OR = 3.3, 95% CrI: 0.45-24). This study highlights the need to optimise radiotherapy strategies, refine combination therapies, and identify predictive biomarkers, providing key insights for personalised treatment approaches in LA-HNSCC. Key Words: Locally advanced head and neck squamous cell carcinoma, Network meta-analysis, Radiotherapy, Pembrolizumab, Overall survival, Progression-free survival, Cisplatin, Toxicity, Immunotherapy, Bayesian analysis.