section name header

Evidence summaries

Interventions for the Treatment of Oral and Oropharyngeal Cancers: Surgical Treatment

The evidence is insufficient to draw conclusions about elective neck dissection (ND) of clinically negative neck nodes at the time of removal of the primary tumour compared to therapeutic (delayed) ND. There is no evidence that radical ND increases overall or disease-free survival compared to more conservative ND surgery. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 12 trials with a total of 2300 participants; 2148 of them had cancers of the oral cavity. Trials were grouped into 7 main comparisons.

  • Elective vs. therapeutic (delayed) neck dissection (ND) in patients with oral cavity cancer and clinically negative neck nodes (5 trials): The meta-analyses of 2 trials found no evidence of either intervention leading to greater overall survival (HR 0.84, 95% CI 0.41 to 1.72; n=571), or disease-free survival (HR 0.73, 95% CI 0.25 to 2.11; n=571), but one trial found a benefit for elective supraomohyoid ND compared to therapeutic ND in overall (RR 0.40, 95% CI 0.19 to 0.84; n=67) and disease-free survival (HR 0.32, 95% CI 0.12 to 0.84; n=67). Four individual trials assessed locoregional recurrence, but could not be meta-analysed; one trial favoured elective ND over therapeutic delayed ND, while the others were inconclusive.
  • Elective radical ND vs. elective selective ND (2 trials): Neither study found evidence of a difference in overall or disease-free survival. A single trial found no evidence of a difference in recurrence.
  • Surgery plus radiotherapy vs. radiotherapy alone (one trial): the data did not allow any conclusions.
  • PET-CT following chemoradiotherapy (with ND only if no or incomplete response) vs. planned ND (either before or after chemoradiotherapy) (one trial): There was no evidence of a difference in mortality (HR 0.92, 95% CI 0.65 to 1.31; n=564).
  • Other comparisons: Three single trials compared surgery plus adjunctive radiotherapy vs. chemoradiotherapy, supraomohyoid ND vs. modified radical ND and super selective ND vs. selective ND. There were no useable data from these trials.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), imprecise results (limited study size for each comparison) and indirectness (recruitment of the patients from 1966 to 2017).

References

  • Bulsara VM, Worthington HV, Glenny AM et al. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev 2018;12():CD006205. [PubMed]

Primary/Secondary Keywords