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Interventions for the treatment of oral cavity and oropharyngeal cancer

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Interventions for the treatment of oral cavity and oropharyngeal cancer : chemotherapy. / Furness, Susan (Lead / Corresponding author); Glenny, Anne-Marie; Worthington, Helen V.; Pavitt, Sue; Oliver, Richard; Clarkson, Jan E.; Macluskey, Michaelina; Chan, Kelvin K. W.; Conway, David I.

In: Cochrane Database of Systematic Reviews, Vol. 2011, No. 4, CD006386, 2011, p. -.

Research output: Contribution to journalScientific review

Harvard

Furness, S, Glenny, A-M, Worthington, HV, Pavitt, S, Oliver, R, Clarkson, JE, Macluskey, M, Chan, KKW & Conway, DI 2011, 'Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy' Cochrane Database of Systematic Reviews, vol 2011, no. 4, CD006386, pp. -.

APA

Furness, S., Glenny, A-M., Worthington, H. V., Pavitt, S., Oliver, R., Clarkson, J. E., Macluskey, M., Chan, K. K. W., & Conway, D. I. (2011). Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database of Systematic Reviews, 2011(4), -[CD006386]doi: 10.1002/14651858.CD006386.pub3

Vancouver

Furness S, Glenny A-M, Worthington HV, Pavitt S, Oliver R, Clarkson JE et al. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database of Systematic Reviews. 2011;2011(4):-. CD006386.

Author

Furness, Susan (Lead / Corresponding author); Glenny, Anne-Marie; Worthington, Helen V.; Pavitt, Sue; Oliver, Richard; Clarkson, Jan E.; Macluskey, Michaelina; Chan, Kelvin K. W.; Conway, David I. / Interventions for the treatment of oral cavity and oropharyngeal cancer : chemotherapy.

In: Cochrane Database of Systematic Reviews, Vol. 2011, No. 4, CD006386, 2011, p. -.

Research output: Contribution to journalScientific review

Bibtex - Download

@article{caa5a4b53384457a9521c13b180e3703,
title = "Interventions for the treatment of oral cavity and oropharyngeal cancer",
author = "Susan Furness and Anne-Marie Glenny and Worthington, {Helen V.} and Sue Pavitt and Richard Oliver and Clarkson, {Jan E.} and Michaelina Macluskey and Chan, {Kelvin K. W.} and Conway, {David I.}",
year = "2011",
volume = "2011",
number = "4",
pages = "--",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Interventions for the treatment of oral cavity and oropharyngeal cancer

T2 - chemotherapy

A1 - Furness,Susan

A1 - Glenny,Anne-Marie

A1 - Worthington,Helen V.

A1 - Pavitt,Sue

A1 - Oliver,Richard

A1 - Clarkson,Jan E.

A1 - Macluskey,Michaelina

A1 - Chan,Kelvin K. W.

A1 - Conway,David I.

AU - Furness,Susan

AU - Glenny,Anne-Marie

AU - Worthington,Helen V.

AU - Pavitt,Sue

AU - Oliver,Richard

AU - Clarkson,Jan E.

AU - Macluskey,Michaelina

AU - Chan,Kelvin K. W.

AU - Conway,David I.

PY - 2011

Y1 - 2011

N2 - <p>Background</p> <p>Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients.</p> <p>Objectives</p> <p>To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes.</p> <p>Search strategy</p> <p>Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 1st December 2010. Reference lists of recent reviews and included studies were also searched to identify further trials.</p> <p>Selection criteria</p> <p>Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included.</p> <p>Data collection and analysis</p> <p>Eighty-nine trials which met the inclusion criteria were assessed for risk of bias and data were extracted by two or more review authors. The primary outcome was total mortality. Trial authors were contacted for additional information or for clarification.</p> <p>Main results</p> <p>There is evidence of a small increase in overall survival associated with induction chemotherapy compared to locoregional treatment alone (25 trials), hazard ratio (HR) of mortality 0.92 (95% confidence interval (CI) 0.84 to 1.00, P = 0.06). Post-surgery adjuvant chemotherapy is associated with improved overall survival compared to surgery +/- radiotherapy alone (10 trials), HR of mortality 0.88 (95% CI 0.79 to 0.99, P = 0.03), and there is some evidence that this improvement may be greater with concomitant adjuvant chemoradiotherapy (4 trials), HR of mortality 0.84 (95% CI 0.72 to 0.98, P = 0.03). In patients with unresectable tumours, there is evidence that concomitant or alternating chemoradiotherapy is associated with improved survival compared to radiotherapy alone (26 trials), HR of mortality 0.78 (95% CI 0.73 to 0.83, P &lt; 0.00001). These findings are confirmed by sensitivity analyses based on studies assessed at low risk of bias. There is insufficient evidence to identify which agent(s) and/or regimen(s) are the most effective. The additional toxicity attributable to chemotherapy in the combined regimens remains unquantified.</p> <p>Authors' conclusions</p> <p>Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy may prolong survival by 8 to 20% and adjuvant concomitant chemoradiotherapy may prolong survival by up to 16%. In patients with unresectable tumours, concomitant or alternating chemoradiotherapy may prolong survival by 10 to 22%. There is insufficient evidence as to which agent or regimen is most effective and the additional toxicity associated with chemotherapy given in addition to radiotherapy and/or surgery cannot be quantified.<br/> <strong>This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</strong></p>

AB - <p>Background</p> <p>Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients.</p> <p>Objectives</p> <p>To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes.</p> <p>Search strategy</p> <p>Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 1st December 2010. Reference lists of recent reviews and included studies were also searched to identify further trials.</p> <p>Selection criteria</p> <p>Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included.</p> <p>Data collection and analysis</p> <p>Eighty-nine trials which met the inclusion criteria were assessed for risk of bias and data were extracted by two or more review authors. The primary outcome was total mortality. Trial authors were contacted for additional information or for clarification.</p> <p>Main results</p> <p>There is evidence of a small increase in overall survival associated with induction chemotherapy compared to locoregional treatment alone (25 trials), hazard ratio (HR) of mortality 0.92 (95% confidence interval (CI) 0.84 to 1.00, P = 0.06). Post-surgery adjuvant chemotherapy is associated with improved overall survival compared to surgery +/- radiotherapy alone (10 trials), HR of mortality 0.88 (95% CI 0.79 to 0.99, P = 0.03), and there is some evidence that this improvement may be greater with concomitant adjuvant chemoradiotherapy (4 trials), HR of mortality 0.84 (95% CI 0.72 to 0.98, P = 0.03). In patients with unresectable tumours, there is evidence that concomitant or alternating chemoradiotherapy is associated with improved survival compared to radiotherapy alone (26 trials), HR of mortality 0.78 (95% CI 0.73 to 0.83, P &lt; 0.00001). These findings are confirmed by sensitivity analyses based on studies assessed at low risk of bias. There is insufficient evidence to identify which agent(s) and/or regimen(s) are the most effective. The additional toxicity attributable to chemotherapy in the combined regimens remains unquantified.</p> <p>Authors' conclusions</p> <p>Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy may prolong survival by 8 to 20% and adjuvant concomitant chemoradiotherapy may prolong survival by up to 16%. In patients with unresectable tumours, concomitant or alternating chemoradiotherapy may prolong survival by 10 to 22%. There is insufficient evidence as to which agent or regimen is most effective and the additional toxicity associated with chemotherapy given in addition to radiotherapy and/or surgery cannot be quantified.<br/> <strong>This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.</strong></p>

KW - Antineoplastic Combined Chemotherapy Protocols [adverse effects; therapeutic use]

KW - Carcinoma, Squamous Cell [drug therapy; mortality; radiotherapy; surgery]

KW - Combined Modality Therapy [methods; mortality]

KW - Mouth Neoplasms [drug therapy; mortality; radiotherapy; surgery]

KW - Oropharyngeal Neoplasms [drug therapy; mortality; radiotherapy; surgery]

KW - Randomized Controlled Trials as Topic

KW - Remission Induction

KW - Survival Analysis

KW - Humans

KW - SQUAMOUS-CELL CARCINOMA

KW - LOCALLY ADVANCED HEAD

KW - RANDOMIZED PHASE-II

KW - CISPLATIN PLUS 5-FLUOROURACIL

KW - TRIAL COMPARING RADIOTHERAPY

KW - COOPERATIVE-ONCOLOGY-GROUP

KW - ADVANCED RESECTABLE HEAD

KW - STAGE-IV HEAD

KW - ACCELERATED HYPERFRACTIONATED RADIOTHERAPY

KW - COMBINED POSTOPERATIVE RADIOTHERAPY

U2 - 10.1002/14651858.CD006386.pub3

DO - 10.1002/14651858.CD006386.pub3

M1 - Scientific review

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 4

VL - 2011

SP - -

ER -

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