Postoperative Therapy for Resected Squamous Cell Carcinoma of the Head and Neck (SCCHN): Initial Findings of an American Radium Society (TM) (ARS) Appropriate Use Criteria Systematic Review (SR)
Margalit D, Sacco A, Bakst R, Beadle B, Beitler J, Chang S, Chen A, Cooper J, Galloway T, Koyfman S, Ridge J, Robbins J, Truong MT, Tsai CJ, Yom S, and Siddiqui F. Postoperative Therapy for Resected Squamous Cell Carcinoma of the Head and Neck (SCCHN): Initial Findings of an American Radium Society (TM) (ARS) Appropriate Use Criteria Systematic Review (SR). International Journal of Radiation Oncology Biology Physics 2020; 108(2):E44.
International Journal of Radiation Oncology Biology Physics
Background: Progress in SCCHN management requires re-evaluation of postoperative therapy for resected SCCHN. Since the ARS and American College of Radiology (ACR) published a literature review and expert consensus guideline on postoperative therapy in 2011, additional relevant clinical trials have been published.
Objectives: To comprehensively evaluate existing prospective clinical studies of postoperative therapy for resected SCCHN using a formalized methodologic approach described by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Protocol, and to identify areas of accepted recommendations, controversy and uncertainty.
Methods: The methodologic protocol for this SR was guided by PRISMA. Ovid Medline and Embase were searched on 01/10/2019 using medical subject headings designed to capture all published studies of HN cancer and postoperative therapy. The PICO (participants, interventions, comparators, outcomes) framework was used to identify published randomized trials, single and multi-arm non-randomized prospective clinical trials, and SRs/meta-analyses that adhered to a published methodology. Longitudinal prospective cohort studies were included if there was a baseline pre-intervention assessment. Excluded studies had <20 patients, were in non-English languages, or were case reports, case series, retrospective studies, large database studies, abstracts, preliminary analyses, narrative reviews, modeling studies, cell-line or non-clinical/non-human studies. Articles were selected if the population included adult patients with stage I-IVB SCCHN and no prior HN radiation who were treated with curative-intent surgery. Included disease sites were: oral cavity, oropharynx, hypopharynx, and larynx. The interventions of interest were postoperative radiation therapy (PORT), chemo-PORT, or postoperative chemotherapy, biologic therapy, targeted therapy, and/or immunotherapy. Studies were selected using Covidence ® software by two independent reviewers based on study relevance related to the inclusion/exclusion criteria. Each study was graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Table.
Results: A total of 5,689 studies were identified. After removal of duplicates, 5,660 studies were screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 96 studies were identified. An additional 4 eligible studies were added that were published after the cut-off date or were not identified through the literature search. Studies with primary oncologic endpoints included 11 SRs, 24 randomized trials, 28 non-randomized trials, and 9 post-hoc analyses of randomized trials. Studies of non-oncologic endpoints included 2 SRs, 1 randomized trial, and 21 non-randomized clinical trials.
Conclusions: This comprehensive, rigorously conducted SR identified 96 published prospective studies of postoperative therapy for SCCHN that constitute the evidence base for the ARS AUC HN Committee’s systematic review. Recommendations and identification of areas of continuing disagreement requiring further research will be generated from this evidence base; these will be described in more detail at the time of presentation.