{ "labelLang" : "hun", "responseDate" : "2024-03-28 22:21", "content" : { "otype" : "JournalArticle", "mtid" : 32684836, "status" : "VALIDATED", "published" : true, "comment" : "Funding Agency and Grant Number: School of Dentistry, The University of Manchester, UK; Cochrane Oral Health, UK; University of Dundee, UK; University of Glasgow, UK; Manchester Academic Health Sciences Centre (MAHSC); NIHR Manchester Biomedical Research Centre, UKNational Institute for Health Research (NIHR); National Institute of Health, National Institute of Dental & Craniofacial Research, USAUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Dental & Craniofacial Research (NIDCR); Central Manchester & Manchester Children's University Hospitals NHS Trust, UK; Cochrane Oral Health Global Alliance; American Association of Public Health. Dentistry, USA; AS-Akademie, Germany; British Association for the Study of Community Dentistry, UK; Canadian Dental Hygienists Association, Canada; Centre for Dental Education and Research at All India Institute of Medical Sciences, India; National Center for Dental Hygiene Research Practice, USA; New York University College of Dentistry, USA; Swiss Society of Endodontology, Switzerland; National Institute for Health Research (NIHR), UKNational Institute for Health Research (NIHR); NIHRNational Institute for Health Research (NIHR); British Society of Paediatric Dentistry, UK; Global Alliance\n Funding text: School of Dentistry, The University of Manchester, UK; Cochrane Oral Health, UK; The University of Dundee, UK; The University of Glasgow, UK; Manchester Academic Health Sciences Centre (MAHSC) and NIHR Manchester Biomedical Research Centre, UK; National Institute of Health, National Institute of Dental & Craniofacial Research, USA; Central Manchester & Manchester Children's University Hospitals NHS Trust, UK; Cochrane Oral Health Global Alliance, Other; The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (oralhealth.cochrane.org/partnerships-alliances). Contributors in recent years have been the American Association of Public Health. Dentistry, USA; AS-Akademie, Germany; the British Association for the Study of Community Dentistry, UK; the British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; the Centre for Dental Education and Research at All India Institute of Medical Sciences, India; the National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; and Swiss Society of Endodontology, Switzerland.; National Institute for Health Research (NIHR), UK; This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. 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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. Objectives 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. Search methods 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. Selection criteria 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. Data collection and analysis 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. Main results 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 < 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. Authors' conclusions 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.", "keywords" : [ { "otype" : "Keyword", "mtid" : 16840, "link" : "/api/keyword/16840", "label" : "SQUAMOUS-CELL CARCINOMA", "published" : true, "oldId" : 16840, "snippet" : true }, { "otype" : "Keyword", "mtid" : 1348408, "link" : "/api/keyword/1348408", "label" : "LOCALLY ADVANCED HEAD", "published" : true, "oldId" : 1348408, "snippet" : true }, { "otype" : "Keyword", "mtid" : 1562153, "link" : "/api/keyword/1562153", "label" : "RANDOMIZED PHASE-II", "published" : true, "snippet" : true }, { "otype" : "Keyword", "mtid" : 2591534, "link" : "/api/keyword/2591534", "label" : "CISPLATIN PLUS 5-FLUOROURACIL", "published" : true, "snippet" : true }, { "otype" : "Keyword", "mtid" : 2591535, "link" : "/api/keyword/2591535", "label" : "ADVANCED RESECTABLE HEAD", "published" : true, "snippet" : true }, { "otype" : "Keyword", "mtid" : 2591536, "link" : "/api/keyword/2591536", "label" : "STAGE-IV HEAD", "published" : true, "snippet" : true }, { "otype" : "Keyword", "mtid" : 2591537, "link" : "/api/keyword/2591537", "label" : "ACCELERATED HYPERFRACTIONATED RADIOTHERAPY", "published" : true, "snippet" : true }, { "otype" : "Keyword", "mtid" : 2591538, "link" : "/api/keyword/2591538", "label" : "COMBINED POSTOPERATIVE RADIOTHERAPY", "published" : true, "snippet" : true }, { "otype" : "Keyword", "mtid" : 2591539, "link" : "/api/keyword/2591539", "label" : "LOCOREGIONALLY ADVANCED-CARCINOMA", "published" : true, "snippet" : true } ], "digital" : null, "printed" : null, "sourceYear" : 2022, "foreignEdition" : true, "foreignLanguage" : true, "fullPublication" : true, "conferencePublication" : false, "nationalOrigin" : null, "missingAuthor" : false, "oaType" : "NONE", "oaCheckDate" : "2023-06-23", "oaFree" : false, "citationCount" : 0, "citationCountUnpublished" : 0, "citationCountWoOther" : 0, "independentCitCountWoOther" : 0, "doiCitationCount" : 0, "wosCitationCount" : 0, "scopusCitationCount" : 0, "independentCitationCount" : 0, "unhandledCitationCount" : 0, "citingPubCount" : 0, "independentCitingPubCount" : 0, "unhandledCitingPubCount" : 0, "citedPubCount" : 6, "citedCount" : 6, "ratings" : [ { "otype" : "SjrRating", "mtid" : 11233060, "link" : "/api/sjrrating/11233060", "label" : "sjr:D1 (2021) Scopus - Pharmacology (medical) COCHRANE DATABASE OF SYSTEMATIC REVIEWS 1469-493X", "listPos" : 25, "rankValue" : 0.1, "type" : "journal", "ratingType" : { "otype" : "RatingType", "mtid" : 10002, "link" : "/api/ratingtype/10002", "label" : "sjr", "code" : "sjr", "published" : true, "snippet" : true }, "subject" : { "otype" : "ClassificationExternal", "mtid" : 2736, "link" : "/api/classificationexternal/2736", "label" : "Scopus - Pharmacology (medical)", "published" : true, "oldId" : 2736, "snippet" : true }, "ranking" : "D1", "calculation" : "DIRECT", "published" : true, "snippet" : true } ], "ratingsForSort" : "D1", "hasCitationDuplums" : false, "userChangeableUntil" : "2022-05-19T09:54:43.398+0000", "directInstitutesForSort" : "", "ownerAuthorCount" : 18, "ownerInstituteCount" : 25, "directInstituteCount" : 0, "authorCount" : 8, "contributorCount" : 0, "hasQualityFactor" : true, "link" : "/api/publication/32684836", "label" : "Parmar Ambika et al. 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