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Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

Slide: 26 of 36

Evidence on the Comparative Effectiveness Regarding Quality of Life and Adverse Events

There were 38 comparative studies; of these, 4 were randomized, controlled trials of IMRT, 3DCRT, or 2DRT; 3 were studies of patients with nasopharyngeal cancer; and 1 was of patients with oropharyngeal or hypopharyngeal cancer. One unpublished, randomized, controlled trial, reported by Nutting et al. at the 2009 Annual Meeting of the American Society of Clinical Oncology, could not be clearly rated because a manuscript was unavailable. One study was rated fair and two others were rated poor due to lack of intention-to-treat analyses. The remaining 34 studies were observational, with significant flaws, such as: lack of comparable groups at baseline; comparing radiotherapy technologies at different points in time (i.e., the study arms were not contemporaneous); and poorly conducted multivariable analyses.