Comparing the effectiveness of non-surgical and surgical treatment modalities in the management of oral cancer – A systematic review and meta-analysis.
Objectives: To answer the question of “how effective are non-surgical treatment modalities in the management of oral cancer, and can they serve as viable alternatives to surgical intervention?” Method: We conducted systematic searches for Randomized Controlled Trials and Controlled Clinical Trials in PubMed, Cochrane, Ovid Medline, and OpenGrey databases. The US National Institutes of Health Ongoing Trials Register and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing and past studies. Identified studies were retrieved and assessed for relevance. Outcome measures: The primary outcomes assessed in the trials included any combination of overall survival, disease-free survival, locoregional control, and recurrence. While secondary outcomes considered were complications of treatment, participants’ satisfaction, costs to participants and health services, and quality of life. Results: Only 5 studies met all inclusion criteria and were selected for qualitative analysis. Two studies comparing radiotherapy with surgery, 1 compared chemoradiotherapy with surgery, and 2 compared brachytherapy with surgery. Conclusion: Based on results from this review, surgery is the mainstay of treatment of non-HPV-associated oral cancer and should always be considered unless surgical intervention is contraindicated. Primary radiotherapy or concurrent chemoradiotherapy may be instituted as non-surgical alternatives when surgery is contraindicated on the condition that clinicians follow the NCCN guidelines.