What do systematic reviews say?

Chemotherapy regimen A (+/- locoregional treatment) vs Chemotherapy regimen B (+/- locoregional treatment)

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  Eight of 11 induction-before-radiotherapy studies reported overall survival; not pooled (heterogeneity). Only Vermorken 2007 significant: cisplatin+5-FU+docetaxel induction HR 0.73 (95% CI 0.57 to 0.93, P = 0.01).…
  8 studies
  GRADE not reported

Non-selective carious tissue removal and conventional restoration (CR) vs Hall Technique (sealing with a preformed metal crown)

Non-selective carious tissue removal and conventional restoration (CR) may leads to higher failure of therapy compared with hall Technique (sealing with a preformed metal crown) (low certainty).

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  30-60 months · Cavitated (not deep) lesions, primary dentition
  OR 8.35 [3.73, 18.68]
  2 studies · 249 participants
  Low

Chemotherapy vs Placebo

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  Types of studies: it was anticipated that there would be no studies comparing chemotherapy with placebo (none were identified).
  0 studies
  No studies found

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 (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 0.85 [0.70, 1.04]
  5 studies · 7427 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… led to lower disease-free survival, induction platinum + 5-fluorouracil prior to… compared with locoregional treatment (radiotherapy and/or surgery) alone; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 0.78 [0.63, 0.97]
  3 studies · 332 participants
  GRADE not reported

Selective carious tissue removal (selective excavation, SE) vs Stepwise carious tissue removal (SW)

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  Permanent and primary dentition
  Cost-effectiveness reported narratively: SE found more cost-effective than SW in permanent (Labib 2019) and primary teeth (Elhennawy 2021); not GRADE-rated.
  2 studies
  GRADE not reported

Sealing using sealant materials vs Selective carious tissue removal (selective excavation, SE)

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  Cavitated lesions, primary dentition
  Lesion progression reported narratively: Dias 2018 1/27 sealed vs 1/21 SE at 24 months; Hesse 2014 0/17 sealed vs 0/17 SE at 18 months; not pooled and not GRADE-rated.
  2 studies
  GRADE not reported

Selective carious tissue removal (selective excavation, SE) vs Stepwise carious tissue removal (SW)

Selective carious tissue removal (selective excavation, SE) probably leads to higher failure of therapy compared with stepwise carious tissue removal (SW) (moderate certainty).

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  12-60 months · Deep lesions, permanent dentition
  OR 2.25 [1.33, 3.82]
  3 studies · 371 participants
  Moderate
• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  12-24 months · Deep lesions, primary dentition
  OR 2.05 [0.49, 8.62]
  2 studies · 126 participants
  Very low

Non-selective carious tissue removal and conventional restoration (CR) vs Hall Technique (sealing with a preformed metal crown)

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  Primary dentition
  Cost-effectiveness reported narratively: HT found more cost-effective than CR in primary teeth (Innes 2011; Santamaria 2018); not GRADE-rated.
  2 studies
  GRADE not reported

Concomitant (concurrent) chemoradiotherapy vs Radiotherapy alone

Concomitant (concurrent) chemoradiotherapy led to lower locoregional control, concurrent chemoradiotherapy (platinum +… compared with radiotherapy alone (non-resectable tumours); GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  RR 0.75 [0.61, 0.93]
  3 studies
  GRADE not reported

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

Non-selective carious tissue removal and conventional restoration (CR) vs Selective carious tissue removal (selective excavation, SE)

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  Cavitated but not deep lesions, primary dentition
  Lesion progression reported narratively: Ribeiro 1999 found 6/24 lesions progressed after 12 months; not pooled and not GRADE-rated.
  1 study
  GRADE not reported

Chemotherapy (any regimen; added to, or compared with, locoregional treatment) vs Locoregional treatment and/or an alternative chemotherapy regimen

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  Harms/toxicity were planned but very little quantitative data suitable for analysis were found; toxicity reported narratively and not quantified or GRADE-rated.
  Studies not reported
  GRADE not reported

Concomitant (concurrent) chemoradiotherapy vs Radiotherapy alone

Concomitant (concurrent) chemoradiotherapy led to lower disease-free survival, concurrent chemoradiotherapy vs radiotherapy… compared with radiotherapy alone (non-resectable tumours); GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 0.74 [0.67, 0.80]
  13 studies
  GRADE not reported

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

Surgery +/- radiotherapy + (adjuvant) chemotherapy led to lower disease-free survival, adjuvant concurrent chemoradiation vs… compared with surgery +/- radiotherapy alone (observation or adjuvant radiotherapy…; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  HR 0.84 [0.72, 0.97]
  4 studies
  GRADE not reported

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

Surgery +/- radiotherapy + (adjuvant) chemotherapy probably leads to lower overall survival, adjuvant concurrent chemoradiation vs adjuvant… 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 0.84 [0.72, 0.98]
  4 studies · 1097 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 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

Sealing using sealant materials vs Non-selective carious tissue removal and conventional restoration (CR)

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  Non-cavitated lesions, primary dentition
  Lesion progression reported narratively: Borges 2012a found 3/26 sealed lesions progressed after 1 year (split-mouth); not pooled and not GRADE-rated.
  1 study
  GRADE not reported

Hall technique vs Non-restorative cavity control (NRCC)

• Interventions for treating cavitated or dentine carious lesions 2021 · Cochrane All outcomes

  Primary dentition
  Cost-effectiveness reported narratively: HT found more cost-effective than NRCC in primary teeth (Santamaria 2018); not GRADE-rated.
  1 study
  GRADE not reported

Chemotherapy regimen A (+/- locoregional treatment) vs Chemotherapy regimen B (+/- locoregional treatment)

• Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy 2021 · Cochrane All outcomes
  Locoregional control reported in 12 studies; not pooled. Olasz 2000 RR 0.50 (0.26 to 0.96); Prevost 2005 RR 1.48 (1.04 to 2.11); Molinari 1982 RR 0.35 (0.19 to 0.66).
  12 studies
  GRADE not reported