What do systematic reviews say?

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

Split-course radiotherapy showed no clear difference in total mortality 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 1.00 [0.82, 1.22]
  1 study · 110 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 total mortality compared with conventional photon radiotherapy; GRADE not reported.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 1.12 [0.92, 1.36]
  1 study · 327 participants
  GRADE not reported

Intensity modulated radiotherapy (IMRT) vs Conventional or other radiotherapy

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  Discussion: 'There are currently no trials of IMRT in this systematic review' (the PARSPORT trial was underway, expected 2013). No eligible trials of intensity modulated radiotherapy identified.
  0 studies
  No studies found

Neutron radiotherapy vs Conventional photon radiotherapy

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

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  HR 1.10 [0.90, 1.34]
  3 studies
  GRADE not reported

Accelerated/split-course radiotherapy vs Conventional (standard) fractionation radiotherapy

Accelerated/split-course radiotherapy showed no clear difference in total mortality compared with conventional (standard) fractionation radiotherapy; GRADE not reported.

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

  5 years
  RR 1.17 [0.57, 2.43]
  1 study · 147 participants
  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

• Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy 2010 · Cochrane All outcomes
  Bjarnason 2009: no statistically significant difference in quality of life scores (data not reported). Morning radiotherapy was associated with significantly less weight loss after 5 months.
  1 study · 216 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

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 total mortality 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 1.38 [0.83, 2.29]
  1 study
  GRADE not reported

Pre-operative radiotherapy (plus surgery) vs surgery

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

• 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

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

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

Hyperfractionated/accelerated radiotherapy showed no clear difference in total mortality 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 0.87 [0.75, 1.00]
  4 studies · 1071 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 total mortality 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 0.67 [0.35, 1.28]
  1 study
  GRADE not reported

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

The review found no eligible studies for this question.

• 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

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, 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

• 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

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

Altered fractionation radiotherapy vs Chemoradiotherapy (concurrent, standard fractionation)

The review found no eligible studies for this question.

• 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