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 (AV) 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 AV (OR = 0. 13, 95% CrI: 0. 0095-1. 6), while radiotherapy with cisplatin and immunotherapy (AIV) 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.
Chen et al. (2026) studied this question.