What do systematic reviews say?

SDF (given at a particular frequency, concentration, or duration) vs SDF (given at a different frequency, concentration, or duration)

• Topical silver diamine fluoride (SDF) for preventing and managing dental caries in children and adults 2024 · Cochrane All outcomes

  24 to 30 months · Children
  1 study (203 children) reported that black or brown staining on treated lesions was commonly found in both groups, with little or no difference according to whether SDF treatment was given in 3 applications at…
  3 studies · 1121 participants
  Very low

Surgery plus radiotherapy vs Chemotherapy (chemoradiotherapy)

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  oral cavity
  Disease-free survival: not reported (Iyer 2015).
  0 studies
  No studies found

Surgery plus radiotherapy vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: not reported.
  0 studies
  No studies found

Surgery vs Radiotherapy alone

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: grade 2+ treatment-related events similar (31/34 radiotherapy vs 33/34 surgery; RR 0.94, 0.83 to 1.06); more hearing loss/neutropenia/constipation/tinnitus with radiotherapy, more oral bleeding/trismus…
  1 study · 68 participants
  Very low

Surgery plus radiotherapy vs Radiotherapy alone

It is very uncertain whether surgery plus radiotherapy changes total mortality compared with radiotherapy alone (very low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.24 [0.10, 0.59]
  1 study · 35 participants
  Very low

Elective radical (comprehensive) neck dissection vs Elective selective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Total mortality: 2 trials reported HR but could not be pooled (different surgical procedures); neither indicated a difference (BHNCSG 1998 HR 1.14, 0.70 to 1.86; Bier 1994 HR 0.87, 0.41 to 1.83); 252 participants (2…
  2 studies · 252 participants
  Very low

Elective neck dissection (at time of primary tumour resection) vs Therapeutic (delayed) neck dissection

Elective neck dissection (at time of primary tumour resection) probably leads to higher adverse events associated with treatment compared with therapeutic (delayed) neck dissection (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  RR 1.31 [1.11, 1.54]
  2 studies · 746 participants
  Moderate

Sentinel node biopsy (neck dissection only if biopsy positive) vs Elective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: Garrel 2020 reported that the number of patients with recurrences in both arms was almost identical; unable to use the data (variable follow-up); 279 participants (1 RCT).
  1 study · 279 participants
  Very low

Surgery plus radiotherapy vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Disease-free survival: not reported.
  0 studies
  No studies found

Sentinel node biopsy (neck dissection only if biopsy positive) vs Elective neck dissection

Sentinel node biopsy (neck dissection only if biopsy positive) showed no clear difference in locoregional recurrence compared with elective neck dissection (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 1.04 [0.91, 1.19]
  1 study · 279 participants
  Low

PET-CT following chemoradiotherapy (neck dissection only if no/incomplete response) vs Planned neck dissection before or after chemoradiotherapy

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: outcome not reported in a usable way (Mehanna 2017: nodal recurrence 3 vs 1; distant metastases 21 vs 23).
  1 study
  GRADE not reported

Supraomohyoid neck dissection vs Modified radical neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: reported but not usable (variable follow-up) (Guo 2014).
  1 study
  GRADE not reported

Surgery vs Radiotherapy alone

Surgery showed no clear difference in total mortality compared with radiotherapy alone (low certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  HR 0.83 [0.09, 7.46]
  1 study · 68 participants
  Low

Elective neck dissection (at time of primary tumour resection) vs Therapeutic (delayed) neck dissection

Elective neck dissection (at time of primary tumour resection) probably leads to lower recurrence compared with therapeutic (delayed) neck dissection (moderate certainty).

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  3 years
  RR 0.58 [0.48, 0.70]
  3 studies · 633 participants
  Moderate

Elective radical (comprehensive) neck dissection vs Elective selective neck dissection

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: not reported.
  0 studies
  No studies found

Surgery vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Locoregional recurrence: not reported.
  0 studies
  No studies found

Surgery plus radiotherapy vs Radiotherapy alone

The review found no eligible studies for this question.

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Recurrence: not reported.
  0 studies
  No studies found

Surgery plus radiotherapy vs Chemotherapy (chemoradiotherapy)

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  oral cavity
  Total mortality: study reported survival significantly better with surgery and RT vs chemoradiotherapy, but no useable data; 32 participants (1 RCT, Iyer 2015 oral cavity subgroup).
  1 study · 32 participants
  Very low

Superselective neck dissection vs Elective selective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes

  36 months
  Disease-free survival: Pandey 2018 reported 83% (superselective) vs 91% (selective) at median 36 months, not significant (P=0.69); unable to analyse (variable follow-up); 32 participants (1 RCT).
  1 study · 32 participants
  Very low

Sentinel node biopsy (neck dissection only if biopsy positive) vs Elective neck dissection

• Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment 2023 · Cochrane All outcomes
  Adverse events: no adverse events were reported (Garrel 2020).
  1 study · 279 participants
  Very low