Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy

• Published in: Cochrane database of systematic reviews 2021-12, Vol.12 (12), p.CD006386
• Main Authors: Parmar, Ambika, Macluskey, Michaelina, Mc Goldrick, Niall, Conway, David I, Glenny, Anne-Marie, Clarkson, Janet E, Worthington, Helen V, Chan, Kelvin Kw
• Format: Article
• Language: English
• Subjects: Cancer; Chemoradiotherapy, Adjuvant; Dentistry & oral health; Ear, nose & throat; Humans; Mouth Neoplasms - drug therapy; Neoplasm Recurrence, Local; ORAL HEALTH; Oropharyngeal Neoplasms - drug therapy
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD006386.pub4

Oral cavity and oropharyngeal cancers are the most common cancers arising in the head and neck. 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. 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. This review updates one last published in 2011. To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal squamous cell carcinoma results in improved overall survival, improved disease-free survival and/or improved locoregional control, when incorporated as either induction therapy given prior to locoregional treatment (i.e. radiotherapy or surgery), concurrent with radiotherapy or in the adjuvant (i.e. after locoregional treatment with radiotherapy or surgery) setting. An information specialist searched 4 bibliographic databases up to 15 September 2021 and used additional search methods to identify published, unpublished and ongoing studies. We included randomised controlled trials (RCTs) where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and that evaluated the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration. For this update, we assessed the new included trials for their risk of bias and at least two authors extracted data from them. Our primary outcome was overall survival (time to death from any cause). Secondary outcomes were disease-free survival (time to disease recurrence or death from any cause) and locoregional control (response to primary treatment). We contacted trial authors for additional information or clarification when necessary. We included 100 studies with 18,813 participants. None of the included trials were at low risk of bias.  For induction chemotherapy, we reported the results for contemporary regimens that will be of interest to clinicians and people being treated for oral cavity and oropharyngeal cancers. Overall, there is insufficient evidence to