What do systematic reviews say?

741 questions · 808 findings · 27 reviews · Oral medicine and oral cancer · related questions CL0289

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No studies found 95 · 11.8%GRADE not reported 498 · 61.6%Very low 134 · 16.6%Low 53 · 6.6%Moderate 27 · 3.3%High 1 · 0.1%

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

Total mortality · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

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

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
HR 1.38 [0.83, 2.29]
1 study
GRADE not reported

Fluconazole (absorbed from GI tract) vs Ketoconazole (absorbed from GI tract)

Clinical: eradication of oral candidiasis · Patients with cancer receiving chemotherapy and/or radiotherapy with overt oral candidiasis

Fluconazole (absorbed from GI tract) showed no clear difference in clinical: eradication of oral candidiasis compared with ketoconazole (absorbed from GI tract); GRADE not reported.

1 finding from 1 review

Interventions for treating oral candidiasis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
RR 1.02 [0.72, 1.42]
1 study · 37 participants
GRADE not reported

Sucralfate vs Salt and soda mouthwash

Time to heal mucositis (days) · People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis

Sucralfate showed no clear difference in time to heal mucositis (days) compared with salt and soda mouthwash; GRADE not reported.

1 finding from 1 review

Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
MD 13.10 [-6.30, 32.50]
1 study · 28 participants
GRADE not reported

Sucralfate vs Salt and soda mouthwash

Average pain scores (0-100 VAS) · People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis

Sucralfate showed no clear difference in average pain scores (0-100 VAS) compared with salt and soda mouthwash; GRADE not reported.

1 finding from 1 review

Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
MD -0.30 [-1.03, 0.43]
1 study · 29 participants
GRADE not reported

Hydromorphone vs morphine

Average pain scores (0-100 VAS) · People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis

Hydromorphone showed no clear difference in average pain scores (0-100 VAS) compared with morphine; GRADE not reported.

1 finding from 1 review

Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
MD 0.60 [-9.24, 10.44]
1 study · 56 participants
GRADE not reported

Pre-operative radiotherapy (plus surgery) vs surgery

Total mortality · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

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

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
HR 0.83 [0.64, 1.07]
1 study
GRADE not reported

Morphine vs Tricyclic antidepressant (nortriptyline)

Average pain scores (0-100 VAS) · People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis

Morphine led to lower average pain scores (0-100 VAS) compared with tricyclic antidepressant (nortriptyline); GRADE not reported.

1 finding from 1 review

Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
MD -19.10 [-31.01, -7.19]
1 study · 39 participants
GRADE not reported

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

Locoregional control · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

1 finding from 1 review

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

Locoregional control · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

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.

1 finding from 1 review

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

Locoregional control · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

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

1 finding from 1 review

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

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

Total mortality · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

Hyperfractionated/accelerated radiotherapy showed no clear difference in total mortality compared with conventional (standard) fractionation radiotherapy; GRADE not reported.

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
HR 0.87 [0.75, 1.00]
4 studies · 1071 participants
GRADE not reported

Clotrimazole 50 mg (partially absorbed) vs Clotrimazole 10 mg (partially absorbed)

Mycological: eradication of oral candidiasis · Patients with cancer receiving chemotherapy and/or radiotherapy with overt oral candidiasis

Clotrimazole 50 mg (partially absorbed) led to higher mycological: eradication of oral candidiasis compared with clotrimazole 10 mg (partially absorbed); GRADE not reported.

1 finding from 1 review

Interventions for treating oral candidiasis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
RR 2.00 [1.11, 3.60]
1 study · 52 participants
GRADE not reported

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

Total mortality · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

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

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
HR 0.67 [0.35, 1.28]
1 study
GRADE not reported

Altered fractionation radiotherapy plus chemotherapy vs Chemoradiotherapy with standard (conventional) fractionation

Outcome not reported · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

The review found no eligible studies for this question.

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
Discussion: 'there are no completed trials of altered fractionation plus chemotherapy versus chemoradiotherapy with standard fractionation.'
0 studies
No studies found

GM-CSF vs povidone‐iodine

Time to heal mucositis (days) · People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis

Granulocyte macrophage-colony stimulating factor (GM-CSF) led to lower time to heal mucositis (days) compared with povidone iodine; GRADE not reported.

1 finding from 1 review

Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
MD -3.50 [-4.14, -2.86]
1 study · 31 participants
GRADE not reported

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

Disease-free survival · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
Accelerated vs conventional, disease free survival: both trials reported this, but substantial clinical and statistical heterogeneity (P = 0.0004, I2 = 92%) meant a pooled analysis was not reported (Analysis 1.3).
2 studies
GRADE not reported

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

Disease-free survival · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

1 finding from 1 review

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

Pre-operative radiotherapy (plus surgery) vs surgery

Locoregional control · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

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

1 finding from 1 review

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

Altered fractionation radiotherapy vs Chemoradiotherapy (concurrent, standard fractionation)

Outcome not reported · People with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials…

The review found no eligible studies for this question.

1 finding from 1 review

Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
Discussion: altered fractionation radiotherapy 'has not been directly compared to chemoradiotherapy'. No eligible head-to-head trials.
0 studies
No studies found

Polyvariant intramuscular immunoglobulin vs placebo

Improvement in mucositis · People with cancer receiving chemotherapy or radiotherapy (or both) who have oral mucositis

Polyvariant intramuscular immunoglobulin led to higher improvement in mucositis compared with placebo; GRADE not reported.

1 finding from 1 review

Interventions for treating oral mucositis for patients with cancer receiving treatment 2010 · Cochrane All outcomes
RR 1.81 [1.24, 2.65]
1 study · 80 participants
GRADE not reported