Outcomes of primary radiotherapy with or without chemotherapy for advanced oral cavity squamous cell carcinoma: Systematic review

Head Neck. 2021 Oct;43(10):3165-3176. doi: 10.1002/hed.26779. Epub 2021 Jun 24.


Background: Surgery with adjuvant radiotherapy is the accepted standard for treatment of advanced oral cavity squamous cell carcinoma (OCSCC); however, alternative evidence suggests that definitive (chemo)radiotherapy may have similar outcomes.

Methods: Systematic review was performed to assess the therapeutic value of radiotherapy or chemoradiotherapy as a primary modality for treating OCSCC. Meta-analysis of outcomes was performed between articles comparing radiotherapy and primary surgical treatment.

Results: Meta-analysis showed less favorable results of radiotherapy compared to surgery: overall survival at 3-years (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.34-0.77) and 5-years (OR = 0.42; 95% CI = 0.29-0.60); disease-specific survival at 3-years (OR = 0.55; 95% CI = 0.32-0.96) and 5-years (OR = 0.55; 95% CI = 0.32-0.96). Odds of feeding tube dependency were higher in primary radiotherapy group (OR = 2.67; 95% CI = 1.27-5.64).

Conclusions: Results of this study support the current perspective favoring primary surgical treatment for OCSCC in the absence of surgical contraindications.

Keywords: chemoradiotherapy; oral cancer; radiotherapy; squamous cell carcinoma; survival.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Carcinoma, Squamous Cell* / drug therapy
  • Chemoradiotherapy
  • Head and Neck Neoplasms*
  • Humans
  • Mouth Neoplasms* / drug therapy
  • Mouth Neoplasms* / radiotherapy
  • Squamous Cell Carcinoma of Head and Neck