Radiotherapy Treatments for Head and Neck Cancer Update: Update. Comparative Effectiveness Review.

摘要

This report is an update of a Comparative Effectiveness Review (CER) published in final form in May 2010 on the benefits and harms of radiotherapy (RT) to treat patients with head and neck cancer (CER No. 20). RT modalities included two-dimensional RT (2DRT), three-dimensional conformal RT (3DCRT), intensity-modulated RT (IMRT), and proton-beam RT (PBT). In this CER update we included 3DCRT, IMRT, PBT, and stereotactic body RT (SBRT). We used the same Key Questions as for CER No. 20, asking whether any of these modalities is more effective than the others (1) in reducing normal tissue toxicity and adverse events, and improving quality of life (QOL); (2) in improving local tumor control, time to disease progression, and survival; or (3) when used in certain anatomic locations or patient subpopulations; and, finally, whether (4) there is more variation in patient outcomes with any modality secondary to user experience, treatment planning, or target volumes. The main finding of CER No. 20 was that late xerostomia was reduced and QOL domains related to xerostomia were improved in patients treated with IMRT compared with those who received either 3DCRT or 2DRT. Evidence was insufficient to draw conclusions on survival or tumor control, adverse events other than late xerostomia (e.g., mucositis, dysphagia, skin toxicities, or osteoradionecrosis of the jaw), whether patient and tumor characteristics affected relative outcomes, or whether physician experience and treatment characteristics affected relative clinical outcomes such as survival or treatment-associated adverse events.