A Cochrane review [Abstract] 1 included 30 studies with a total of 6535 subjects evaluating the effect of different radiotherapy regimens (altered fractionation versus conventional, neutron therapy versus photon therapy, preoperative versus postoperative and daily timing of radiotherapy) in patients with newly diagnosed oral cavity or oropharyngeal cancer.
In the 13 trials providing data on altered fractionation radiotherapy regimen compared to a conventional schedule significant reduction in total mortality (HR 0.86, 95% CI 0.76 to 0.98) and locoregional control (HR 0.79, 95% CI 0.70 to 0.89) was seen. A statistically significant difference was not shown for disease free survival. The regimens classed as 'hyperfractionated' were the only pooled group to show a statistically significant difference in favour of the altered fractionation for the outcome of total mortality (HR 0.78, 95% CI 0.68 to 0.90).
No statistically significant difference was shown between neutron or photon radiotherapy, between pre-operative and post-operative radiotherapy versus post-operative radiotherapy alone, between pre-operative radiotherapy versus surgery alone or between morning radiotherapy versus afternoon radiotherapy. Accurate methods of reporting adverse events are needed in order to assess the clinical performance of different radiotherapy regimens.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).
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