What do systematic reviews say?

Surgery plus whole brain radiotherapy (WBRT) vs stereotactic radiosurgery plus WBRT

Surgery plus whole brain radiotherapy (WBRT) showed no clear difference in overall survival compared with stereotactic radiosurgery plus WBRT (low certainty).

• Surgery versus stereotactic radiotherapy for people with single or solitary brain metastasis 2018 · Cochrane Headline outcomes only
  HR 0.53 [0.2, 1.42]
  1 study · 21 participants
  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 overall survival 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 0.82 [0.69, 0.97]
  3 studies · 1421 participants
  Moderate

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 overall survival 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 0.99 [0.62, 1.57]
  2 studies · 271 participants
  Very low

Hypofractionated radiotherapy vs daily conventionally fractionated radiotherapy

Hypofractionated radiotherapy showed no clear difference in overall survival for subgroup aged ≥ 60 years glioblastoma compared with daily conventionally fractionated radiotherapy (high certainty).

• External beam radiation dose escalation for high grade glioma 2020 · Cochrane Headline outcomes only
  HR 1.16 [0.92, 1.46]
  2 studies · 293 participants
  High

Summary of findings table ‐ Postmastectomy radiotherapy (PMRT) vs no PMRT

Summary of findings table ‐ Postmastectomy radiotherapy (PMRT) probably leads to lower overall survival (OS) compared with no PMRT (moderate certainty).

• Post‐mastectomy radiotherapy for women with early breast cancer and one to three positive lymph nodes 2023 · Cochrane Headline outcomes only
  HR 0.76 [0.6, 0.97]
  1 study · 552 participants
  Moderate

Surgery +/- radiotherapy + (adjuvant) chemotherapy vs Surgery +/- radiotherapy alone (observation or adjuvant radiotherapy only)

Surgery +/- radiotherapy + (adjuvant) chemotherapy showed no clear difference in overall survival, adjuvant chemotherapy vs observation alone… compared with surgery +/- radiotherapy alone (observation or adjuvant radiotherapy… (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 0.95 [0.73, 1.22]
  5 studies · 353 participants
  Moderate

Induction chemotherapy plus locoregional treatment (radiotherapy and/or surgery) vs Locoregional treatment (radiotherapy and/or surgery) alone

Induction chemotherapy plus locoregional treatment (radiotherapy… showed no clear difference in overall survival, induction platinum + 5-fluorouracil prior to… compared with locoregional treatment (radiotherapy and/or surgery) alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 1.06 [0.71, 1.60]
  1 study · 198 participants
  Low

Induction chemotherapy plus locoregional treatment (radiotherapy and/or surgery) vs Locoregional treatment (radiotherapy and/or surgery) alone

Induction chemotherapy plus locoregional treatment (radiotherapy… showed no clear difference in overall survival, induction cisplatin + 5-fluorouracil prior to… compared with locoregional treatment (radiotherapy and/or surgery) alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 0.71 [0.37, 1.35]
  2 studies · 389 participants
  Low

Induction chemotherapy plus locoregional treatment (radiotherapy and/or surgery) vs Locoregional treatment (radiotherapy and/or surgery) alone

Induction chemotherapy plus locoregional treatment (radiotherapy… showed no clear difference in overall survival, induction cisplatin + 5-fluorouracil + docetaxel… compared with locoregional treatment (radiotherapy and/or surgery) alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 1.08 [0.80, 1.44]
  3 studies · 760 participants
  Low

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy leads to lower overall survival by chemo‐/radiotherapy ‐ Chemotherapy only compared with primary surgery (high certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.83 [0.75, 0.91]
  10 studies · 2033 participants
  High

Perioperative chemotherapy vs primary surgery

Perioperative chemotherapy probably leads to lower overall survival by chemo‐/radiotherapy ‐ Chemoradiotherapy compared with primary surgery (moderate certainty).

• Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach,… 2013 · Cochrane Headline outcomes only
  HR 0.7 [0.5, 0.99]
  4 studies · 389 participants
  Moderate

Bethanechol vs Artificial saliva

Bethanechol showed no clear difference in overall survival compared with artificial saliva; GRADE not reported.

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

  40 weeks postRT
  RR 1.59 [0.43, 5.84]
  1 study · 43 participants
  GRADE not reported

Keratinocyte growth factor (KGF; palifermin or repifermin), intravenous vs placebo

Palifermin showed no clear difference in overall survival compared with placebo (moderate certainty).

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

  42 to 72 months from baseline
  HR 1.00 [0.72, 1.39]
  3 studies
  Moderate

Amifostine (intravenous) vs Amifostine (subcutaneous)

Amifostine (intravenous) showed no clear difference in overall survival 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 1.36 [0.89, 2.10]
  1 study
  GRADE not reported

Pilocarpine vs no treatment/placebo

It is very uncertain whether pilocarpine changes overall survival compared with no treatment/placebo (very low certainty).

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

  Up to and including 6 months postRT
  RR 1.07 [0.80, 1.43]
  1 study · 60 participants
  Very low

Chinese medicine vs no treatment/placebo

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

  12 months postRT
  Insufficient evidence to determine any effect on overall survival (Hu 2005; Analysis 6.4)
  1 study
  GRADE not reported

Amifostine vs no treatment/placebo

It is very uncertain whether amifostine changes overall survival compared with no treatment/placebo (very low certainty).

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

  12 to 24 months postRT
  HR 1.18 [0.85, 1.66]
  2 studies · 271 participants
  Very low

Minimally invasive surgery vs Standard therapy alone (radiotherapy or chemoradiotherapy)

The review found no eligible studies for this question.

• Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small‐volume primary oropharyngeal carcinoma 2016 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Hysterectomy (radical) with neoadjuvant chemotherapy vs chemoradiotherapy alone

Hysterectomy (radical) with neoadjuvant chemotherapy showed no clear difference in overall survival Median compared with chemoradiotherapy alone (moderate certainty).

• Hysterectomy with radiotherapy or chemotherapy or both for women with locally advanced cervical cancer 2022 · Cochrane Headline outcomes only
  HR 0.94 [0.76, 1.16]
  2 studies · 1253 participants
  Moderate

Hysterectomy (simple or radical) with neoadjuvant chemotherapy vs Radiotherapy alone

Hysterectomy (simple or radical) with neoadjuvant chemotherapy probably leads to lower overall survival Median compared with radiotherapy alone (moderate certainty).

• Hysterectomy with radiotherapy or chemotherapy or both for women with locally advanced cervical cancer 2022 · Cochrane Headline outcomes only
  HR 0.71 [0.55, 0.93]
  3 studies · 571 participants
  Moderate