Cochrane · intervention · CD006386
Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy
Parmar, A, Macluskey, M, Mc Goldrick, N, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
18
current version
GRADE rated
7
No studies
2
Included studies
100
as reported
No studies 2 · 11.1%Ungraded 9 · 50%Very low 0 · 0%Low 3 · 16.7%Moderate 4 · 22.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with primary squamous cell carcinoma of the oral cavity (ICD-O C01-C06) or oropharynx (ICD-O C09-C10); head and neck cancer trials included where >50% of participants have oral cavity/oropharyngeal cancer or separate data available | Oral cavity and oropharyngeal (and mixed head and neck, >50% oral/oropharyngeal) squamous cell carcinoma (n=100 trials; 18,813 participants) |
| Intervention | Chemotherapy (cytotoxic/antineoplastic drugs) by any mode of administration, as induction, concomitant or adjuvant treatment, +/- radiotherapy and/or surgery | Induction chemotherapy plus LRT (n=36); surgery + adjuvant treatment (n=varies); concurrent chemoradiotherapy (n=varies); head-to-head chemotherapy regimens (n=varies) |
| Comparison | Other chemotherapy / different regimen, timing or mode of administration; surgical combinations; radiotherapy combinations; no chemotherapy | Locoregional treatment alone (radiotherapy and/or surgery); observation/no chemotherapy; alternative chemotherapy regimen |
| Outcomes | Primary: Overall survival (time to death from any cause). Secondary: Disease-free survival (time to disease recurrence or death); Locoregional control (response to primary treatment) | Overall survival; Disease-free survival; Locoregional control |
| Study designs | Randomised controlled trials (minimum 6 months follow-up in PUB2 onwards) | Randomised controlled trials (RCT) |
| Timing | Not specified | Follow-up 3-8 years |
Search date: 2021-09. Databases: Cochrane Oral Health's Trials Register; CENTRAL; MEDLINE (OVID); Embase (OVID); US National Institutes of Health Trials Registry (ClinicalTrials.gov); WHO ICTRP
Questions and results
Show all 4 versionsInduction chemotherapy plus locoregional treatment (radiotherapy and/or surgery) vs Locoregional treatment (radiotherapy and/or surgery) alone
Population: People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival, induction platinum + 5-fluorouracil prior to surgery vs surgery alone | HR 1.06 [0.71, 1.60] 200; 500; 700 per 1000 (low; medium; high risk population) vs 211; 520; 721 per 1000 | 1 study · 198 participants | Low Downgraded: imprecision |
Disease-free survival, induction platinum + 5-fluorouracil prior to radiotherapy vs radiotherapy alone | HR 0.78 [0.63, 0.97] | 3 studies · 332 participants | Ungraded |
Overall survival, induction cisplatin + 5-fluorouracil + docetaxel prior to concurrent chemoradiation (cisplatin) vs concurrent chemoradiation (cisplatin) | HR 1.08 [0.80, 1.44] 200; 500; 700 per 1000 (low; medium; high risk population) vs 214; 527; 728 per 1000 | 3 studies · 760 participants | Low Downgraded: imprecision, inconsistency |
Locoregional control, induction cisplatin + 5-fluorouracil + docetaxel prior to concurrent chemoradiation vs concurrent chemoradiation | RR 0.80 [0.64, 0.99] | 3 studies | Ungraded |
Overall survival, induction platinum + 5-fluorouracil prior to radiotherapy vs radiotherapy alone | HR 0.85 [0.70, 1.04] 200; 500; 700 per 1000 (low; medium; high risk population) vs 173; 445; 641 per 1000 | 5 studies · 7427 participants | Moderate Downgraded: inconsistency |
Overall survival, induction cisplatin + 5-fluorouracil prior to concurrent chemoradiation (cisplatin) vs concurrent chemoradiation (cisplatin) | HR 0.71 [0.37, 1.35] 200; 500; 700 per 1000 (low; medium; high risk population) vs 147; 389; 575 per 1000 | 2 studies · 389 participants | Low Downgraded: imprecision, inconsistency |
Surgery +/- radiotherapy + (adjuvant) chemotherapy vs Surgery +/- radiotherapy alone (observation or adjuvant radiotherapy only)
Population: People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival, adjuvant chemotherapy vs observation alone following surgery | HR 0.95 [0.73, 1.22] 200; 500; 700 per 1000 (low; medium; high risk population) vs 191; 482; 681 per 1000 | 5 studies · 353 participants | Moderate Downgraded: imprecision |
Disease-free survival, adjuvant concurrent chemoradiation vs adjuvant radiotherapy (pooled) | HR 0.84 [0.72, 0.97] | 4 studies | Ungraded |
Overall survival, adjuvant concurrent chemoradiation vs adjuvant radiotherapy | HR 0.84 [0.72, 0.98] 200; 500; 700 per 1000 (low; medium; high risk population) vs 171; 441; 636 per 1000 | 4 studies · 1097 participants | Moderate Downgraded: inconsistency |
Concomitant (concurrent) chemoradiotherapy vs Radiotherapy alone (non-resectable tumours)
Population: People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Locoregional control, concurrent chemoradiotherapy (platinum + 5-fluorouracil) vs radiotherapy alone (pooled) | RR 0.75 [0.61, 0.93] | 3 studies | Ungraded |
Disease-free survival, concurrent chemoradiotherapy vs radiotherapy alone (pooled) | HR 0.74 [0.67, 0.80] | 13 studies | Ungraded |
Overall survival, concurrent chemoradiotherapy vs radiotherapy alone (pooled) | HR 0.74 [0.67, 0.83] 200; 500; 700 per 1000 (low; medium; high risk population) vs 156; 410; 599 per 1000 | 24 studies · 2852 participants | Moderate Downgraded: inconsistency |
Chemotherapy regimen A (+/- locoregional treatment) vs Chemotherapy regimen B (+/- locoregional treatment)
Population: People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival, chemotherapy regimen A vs regimen B | 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 | Ungraded |
Disease-free survival, chemotherapy regimen A vs regimen B | Induction cisplatin+5-FU+docetaxel vs cisplatin+5-FU: disease-free survival HR 0.72 (95% CI 0.57 to 0.91, P = 0.006; Vermorken 2007). Prior to concurrent chemoradiation: Posner 2007 HR 0.71 (0.56 to 0.90, P = 0.005).… | 2 studies | Ungraded |
Locoregional control, chemotherapy regimen A vs regimen B | 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 | Ungraded |
Chemotherapy (any regimen; added to, or compared with, locoregional treatment) vs Locoregional treatment and/or an alternative chemotherapy regimen
Population: People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life | Quality of life was a planned (protocol) outcome but no included trial provided usable quality-of-life data; the protocol was modified to report only survival/response outcomes. | 0 studies | No studies |
Toxicity / adverse effects (harms) of chemotherapy | Harms/toxicity were planned but very little quantitative data suitable for analysis were found; toxicity reported narratively and not quantified or GRADE-rated. | NR | Ungraded |
Chemotherapy vs Placebo
Population: People receiving curative-intent treatment for oral cavity and oropharyngeal (squamous cell) cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Types of studies: it was anticipated that there would be no studies comparing chemotherapy with placebo (none were identified). | 0 studies | No studies |