What do systematic reviews say?

Tyrosine kinase inhibitor (erlotinib, gefitinib or lapatinib) plus standard therapy (radiotherapy or chemoradiotherapy) vs Standard therapy alone (radiotherapy or chemoradiotherapy)

It is very uncertain whether tyrosine kinase inhibitor (erlotinib, gefitinib or lapatinib) plus… changes locoregional control compared with standard therapy alone (radiotherapy or chemoradiotherapy) (very low certainty).

• Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy 2015 · Cochrane All outcomes

  40 to 60 months
  HR 0.89 [0.53, 1.49]
  2 studies · 271 participants
  Very low

EGFR monoclonal antibody (cetuximab or nimotuzumab) plus standard therapy (radiotherapy or chemoradiotherapy) vs Standard therapy alone (radiotherapy or chemoradiotherapy)

EGFR monoclonal antibody (cetuximab or nimotuzumab) plus standard… probably leads to lower locoregional control compared with standard therapy alone (radiotherapy or chemoradiotherapy) (moderate certainty).

• Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy 2015 · Cochrane All outcomes

  24 to 70 months
  HR 0.68 [0.52, 0.89]
  1 study · 424 participants
  Moderate

Non-specific immunotherapy (recombinant interleukin-2 or BCG cell wall preparation) plus standard therapy vs Standard therapy alone (radiotherapy or chemoradiotherapy)

• Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy 2015 · Cochrane All outcomes

  24 to 70 months · Recombinant interleukin-2 + neoadjuvant chemotherapy (Mantovani 1998), tumour response
  Response to treatment (Mantovani 1998; neoadjuvant chemotherapy + rIL-2 vs chemotherapy alone): complete response 4/13 vs 3/15; partial response 6/13 vs 9/15. Narrative only; no GRADE rating.
  1 study · 33 participants
  GRADE not reported

Mixed beam (neutron and photon) radiotherapy vs Conventional photon radiotherapy

Mixed beam (neutron and photon) radiotherapy showed no clear difference in locoregional control compared with conventional photon radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 1.04 [0.84, 1.29]
  1 study · 327 participants
  GRADE not reported

Altered fractionation radiotherapy (hyperfractionated and/or accelerated) vs Conventional (standard) fractionation radiotherapy

Hyperfractionated/accelerated radiotherapy led to lower locoregional control compared with conventional (standard) fractionation radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 0.84 [0.72, 0.99]
  4 studies · 1071 participants
  GRADE not reported
• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 0.79 [0.70, 0.89]
  11 studies
  GRADE not reported

Accelerated radiotherapy with concomitant boost vs Conventional (standard) fractionation radiotherapy

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  Accelerated/boost vs conventional, locoregional control: IPD from one trial (Fu 2000); a statistically significant difference in favour of the accelerated schedule with boost was shown (Analysis 1.2). No numeric…
  1 study
  GRADE not reported

Low dose rate interstitial radiotherapy vs High dose rate interstitial radiotherapy

Low dose rate interstitial radiotherapy showed no clear difference in locoregional control compared with high dose rate interstitial radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 1.00 [0.16, 6.44]
  1 study · 59 participants
  GRADE not reported

Hyperfractionated radiotherapy vs Conventional (standard) fractionation radiotherapy

Hyperfractionated radiotherapy led to lower locoregional control compared with conventional (standard) fractionation radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 0.74 [0.62, 0.89]
  3 studies · 966 participants
  GRADE not reported

Split‐course radiotherapy (8 fractions, 30 Gy) vs Accelerated radiotherapy

Split-course radiotherapy showed no clear difference in locoregional control compared with accelerated radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes

  2 years
  RR 1.33 [0.67, 2.67]
  1 study · 110 participants
  GRADE not reported

Pre-operative and post-operative radiotherapy vs Post-operative radiotherapy alone

Pre-operative and post-operative radiotherapy showed no clear difference in locoregional control compared with post-operative radiotherapy alone; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 1.13 [0.78, 1.64]
  1 study
  GRADE not reported

Neutron radiotherapy vs Conventional photon radiotherapy

Neutron radiotherapy showed no clear difference in locoregional control compared with conventional photon radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes

  5 years
  RR 0.97 [0.69, 1.36]
  1 study
  GRADE not reported

Lower total dose radiotherapy (67.2 Gy over 5.6 weeks) vs conventional dose RT

Lower total dose radiotherapy (67.2 Gy over 5.6 weeks) showed no clear difference in locoregional control compared with conventional/standard total dose radiotherapy (72 Gy); GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 1.13 [0.78, 1.64]
  1 study
  GRADE not reported

Hyperfractionated/accelerated split-course radiotherapy vs Accelerated radiotherapy with concomitant boost

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  Fu 1995: no significant difference in locoregional control; data not presented in a way that allows calculation of an HR.
  1 study · 75 participants
  GRADE not reported

Radiotherapy (morning) vs Afternoon radiotherapy

Morning radiotherapy showed no clear difference in locoregional control compared with afternoon radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 0.92 [0.60, 1.42]
  1 study · 216 participants
  GRADE not reported

Accelerated radiotherapy (no split, boost or hyperfractionation) vs Conventional (standard) fractionation radiotherapy

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  Accelerated vs conventional, locoregional control: one trial (Skladowski 2006); a statistically significant difference in favour of the altered fractionation was shown (Analysis 1.2). No numeric estimate given.
  1 study
  GRADE not reported

Higher total dose radiotherapy (76.8 Gy over 6.4 weeks) vs conventional dose RT

Higher total dose radiotherapy (76.8 Gy over 6.4 weeks) showed no clear difference in locoregional control compared with conventional/standard total dose radiotherapy (72 Gy); GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 0.78 [0.55, 1.11]
  1 study
  GRADE not reported

Hyperfractionated/accelerated/split-course radiotherapy vs Conventional (standard) fractionation radiotherapy

Hyperfractionated/accelerated/split-course radiotherapy showed no clear difference in locoregional control compared with conventional (standard) fractionation radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 0.86 [0.74, 1.01]
  4 studies · 1299 participants
  GRADE not reported

Pre-operative radiotherapy (plus surgery) vs surgery

Pre-operative radiotherapy (plus surgery) showed no clear difference in locoregional control compared with surgery alone; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes

  Timing unclear
  RR 0.63 [0.28, 1.46]
  1 study
  GRADE not reported

Amifostine (intravenous) vs Amifostine (subcutaneous)

Amifostine (intravenous) showed no clear difference in locoregional tumour control compared with amifostine (subcutaneous); GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  48 months postRT
  HR 1.34 [0.76, 2.36]
  1 study
  GRADE not reported

Amifostine vs no treatment/placebo

Amifostine showed no clear difference in locoregional tumour control compared with no treatment/placebo; GRADE not reported.

• Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy 2017 · Cochrane All outcomes

  12 to 24 months postRT
  HR 0.90 [0.74, 1.11]
  2 studies · 279 participants
  GRADE not reported