title: Induction chemotherapy prior to surgery with or without postoperative radiotherapy for oral cavity cancer patients: Systematic review and meta-analysis.
abstract: BACKGROUND
  Locoregionally advanced oral cavity cancers are aggressive tumours with high risk of relapse after definitive treatment. This study was performed to assess the effectiveness and safety of induction chemotherapy prior to surgery for untreated oral cavity cancer patients.
  
  
  METHODS
  Only prospective phase III randomised studies comparing induction chemotherapy followed by surgery with or without postoperative radiotherapy (Chemo Group) compared with surgery with or without postoperative radiotherapy (Control Group) were eligible. Two of the authors independently selected and assessed the studies regarding eligibility criteria and risk of bias.
  
  
  RESULTS
  Two studies were selected. A total of 451 patients were randomly assigned to Chemo Group (n=226) versus Control Group (n=225). Most patients had tumours at clinical stages III/IV (89.1%). Both trials were classified as having low risk of bias. No significant overall benefit in favour of induction chemotherapy was found regarding loco-regional recurrence, disease-free survival and overall survival. A subgroup analysis of individual data from cN2 patients showed statistically significant overall survival benefit in favour of induction chemotherapy. The included studies did not directly compare toxicity between the groups and no statistical analysis was performed regarding safety outcomes.
  
  
  CONCLUSIONS
  Based on the available studies, induction chemotherapy when administered before surgery with curative intent did not improve clinical outcomes in locoregionally advanced oral cavity cancer patients. Clinically assessed N2 patients might benefit from induction chemotherapy.
authors: Department of Radiation Oncology, Hospital Sírio-Libanês and Instituto do Câncer do Estado de São Paulo - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: gnmarta@uol.com.br.
authors: Gustavo N
authors: GN
authors: Marta
authors: Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-PM), São Paulo, Brazil. Electronic address: rachelriera@hotmail.com.
authors: Rachel
authors: R
authors: Riera
authors: Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: paolo.Bossi@istitutotumori.mi.it.
authors: Paolo
authors: P
authors: Bossi
authors: Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China. Electronic address: zhonglp@hotmail.com.
authors: Lai-ping
authors: LP
authors: Zhong
authors: Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: lisa.licitra@istitutotumori.mi.it.
authors: Lisa
authors: L
authors: Licitra
authors: Brazilian Cochrane Center and Post Graduation Program of Internal Medicine Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Electronic address: vcrisrufa@uol.com.br.
authors: Cristiane R
authors: CR
authors: Macedo
authors: Department of Clinical Oncology, Hospital Sírio-Libanês and Instituto do Câncer do Estado de São Paulo - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: gilberto.castro@usp.br.
authors: Gilberto
authors: G
authors: de Castro Junior
authors: Department of Head and Neck Cancer, Hospital do Câncer de Barretos - Fundação Pio XII, São Paulo, Brazil. Electronic address: alopescarvalho@uol.com.br.
authors: André L
authors: AL
authors: Carvalho
authors: Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, USA. Electronic address: wnwillia@mdanderson.org.
authors: William N
authors: WN
authors: William
authors: Department of Head and Neck Surgery and Otorhinolaryngology, AC. Camargo Cancer Center, São Paulo, Brazil. Electronic address: lp_kowalski@uol.com.br.
authors: Luis Paulo
authors: LP
authors: Kowalski
mesh_terms: D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D009062:Mouth Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D011184:Postoperative Period; D057234:Preoperative Period; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Induction chemotherapy; Neoplasms; Oral cavity; Prognosis; Radiotherapy; Surgery; Survival; Treatment